Normothermia is the key for the treatment of internal thoracic artery spasm.
BACKGROUND
Free flow of the internal thoracic artery decreases commonly after harvesting because of spasm. Tissue heat loss is inevitable during surgery. The aim of this study was to compare the internal thoracic artery pedicle rewarming method with topical papaverine applications in different thermal conditions.


METHODS
Patients (n = 120) were organized in to 6 equally sized groups. The effects of topical papaverine application at room temperature, topical heated papaverine (at 37 degrees C) application, internal thoracic artery pedicle storage in normothermic conditions, pedicle storage in normothermic conditions combined with topical papaverine application, and pedicle storage in normothermic conditions combined with topical heated papaverine application were investigated. In the control group, no treatment was applied and the pedicle was stored in room temperature conditions. We measured internal thoracic artery free flows at 3 stages: at the initiation of harvesting, after total harvesting, and after antispasmodic treatment. Durations of the stages were recorded. At each stage hemodynamic parameters, tissue and core temperatures were also monitored.


RESULTS
Internal thoracic artery pedicle temperature significantly decreased simultaneously with the free flow after the harvesting procedure. Recovery of the physiologic temperature state, provided by storing the internal thoracic artery pedicle in normothermic conditions, improved the flow and increased the efficiency of topically applied papaverine on the vasospasm of the internal thoracic artery.


CONCLUSIONS
Topical application of heated papaverine itself does not warm pedicle tissue, but papaverine efficiency increases when the pedicle is stored in normothermic conditions. Preserving internal thoracic artery pedicles in normothermic conditions can be the preferred treatment for spasms.
Tarhan
Ibrahim Arif
IA
Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Kehlibar
Tamer
T
Yilmaz
Mehmet
M
Arslan
Yucesin
Y
Dumantepe
Mert
M
Berkoz
Kazim
K
Pancaroglu
Cansin
C
Ozler
Azmi
A
D000368:Aged; D003329:Coronary Vasospasm / Q000517:prevention & control*; D005260:Female; D006358:Hot Temperature; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D008875:Middle Aged; D010208:Papaverine / Q000008:administration & dosage*; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014654:Vascular Patency; D014665:Vasodilator Agents / Q000008:administration & dosage
D014665:Vasodilator Agents; D010208:Papaverine