A new antispastic solution for arterial grafting: Nicardipine and nitroglycerin cocktail in preparation of internal thoracic and radial arteries for coronary.

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Presentation transcript:

A new antispastic solution for arterial grafting: Nicardipine and nitroglycerin cocktail in preparation of internal thoracic and radial arteries for coronary surgery Guo-Wei He, MD, PhD, DSc, Li Fan, MD, PhD, Anthony Furnary, MD, Qin Yang, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 136, Issue 3, Pages 673-680.e2 (September 2008) DOI: 10.1016/j.jtcvs.2007.12.019 Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Percentage of relaxation induced by nicardipine (30 μmol/L) and glycerol trinitrate (nitroglycerin, NTG 30 μmol/L) in ITA (A, n = 8) and RA (B, n = 6) rings precontracted by U46619 (10 nM), K+ (70 mmol/L), or NE (10 μM). Values are expressed as mean ± standard error (SE). P > .05 (one-way analysis of variance followed by Bonferroni's multiple comparison test). ITA, Internal thoracic artery; RA, radial artery; NE, norepinephrine; K+, potassium chloride. The Journal of Thoracic and Cardiovascular Surgery 2008 136, 673-680.e2DOI: (10.1016/j.jtcvs.2007.12.019) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Onset and time course of the relaxation induced by nicardipine (30 μmol/L) and glycerol trinitrate (nitroglycerin, NTG, 30 μmol/L) in ITA (A, n = 8) and RA (B, n = 6) rings precontracted by U46619 (10 nM), K+ (70 mmol/L), or NE (10 μM). Values are expressed as mean ± SE. Note that in the first 20 minutes, relaxation reached almost the maximal in both ITA and RA rings. NE, Norepinephrine; K+, potassium chloride. The Journal of Thoracic and Cardiovascular Surgery 2008 136, 673-680.e2DOI: (10.1016/j.jtcvs.2007.12.019) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Mean concentration-contraction (g) curves for U46619 (−10 to −6.5 log M) in ITA (A, n = 8) and RA (B, n = 7) rings pretreated with or without (control) treatment of NG (nicardipine 30 μmol/L; NTG 30 μmol/L) for 30 minutes. Values are expressed as mean ± SE. ∗∗P < .01, ∗∗∗P < .001, compared with control. NG, Nicardipine and nitroglycerin. The Journal of Thoracic and Cardiovascular Surgery 2008 136, 673-680.e2DOI: (10.1016/j.jtcvs.2007.12.019) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Mean concentration-contraction (g) curves for K+ (5–100 mmol/L) in ITA (A, n = 8) and RA (B, n = 7) rings pretreated with or without (control) treatment of NG (nicardipine 30 μmol/L; NTG 30 μmol/L) for 30 minutes. Values are expressed as mean ± SE. ∗∗P < .01, ∗∗∗P < .001, compared with control. NG, Nicardipine and nitroglycerin. The Journal of Thoracic and Cardiovascular Surgery 2008 136, 673-680.e2DOI: (10.1016/j.jtcvs.2007.12.019) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Mean concentration- (mmol/L) contraction (g) curves for NE (−8.5 to −5 log M) in (A) ITA (n = 8) and (B) RA (n = 7) rings pretreated with or without (control) treatment of NG (nicardipine 30 μmol/L; NTG 30 μmol/L) for 30 minutes. Values are expressed as mean ± SE. ∗∗P < .01, ∗∗∗P < .001, compared with control. NG, Nicardipine and nitroglycerin. The Journal of Thoracic and Cardiovascular Surgery 2008 136, 673-680.e2DOI: (10.1016/j.jtcvs.2007.12.019) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Mean concentration- (log M) relaxation (%) curves for ACh (−10 to −6 Mean concentration- (log M) relaxation (%) curves for ACh (−10 to −6.5 log M) in U46619-contracted ITA (A, n = 6) and RA (B, n = 8) rings pretreated with or without NG (nicardipine 30 μmol/L; NTG 30 μmol/L) for 30 minutes. Values are expressed as mean ± SE. P > .05, compared with control (2-way analysis of variance followed by Bonferroni tests). NG, Nicardipine and nitroglycerin. The Journal of Thoracic and Cardiovascular Surgery 2008 136, 673-680.e2DOI: (10.1016/j.jtcvs.2007.12.019) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Schema showing the mechanism of the antispastic effect of NG cocktail Schema showing the mechanism of the antispastic effect of NG cocktail. Nicardipine, as a calcium channel blocker, is particularly effective against the mechanism of vasoconstriction through membrane depolarization that is voltage-dependent31 but less effective in receptor-mediated mechanisms. In contrast, NTG, as an NO donor, is effective in all mechanisms and particularly effective in receptor-mediated mechanisms.1NG, Nicardipine and nitroglycerin; NTG, nitroglycerin; PGF2α, prostaglandin F2α; 5-HT, 5-hydroxytryptamine. The Journal of Thoracic and Cardiovascular Surgery 2008 136, 673-680.e2DOI: (10.1016/j.jtcvs.2007.12.019) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions