Radial Artery Graft Treatment with Phenoxybenzamine is Safe and Reduces Perioperative Myocardial Injury
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Objective: To evaluate the safety and efficacy of radial artery (RA) post-harvest treatment with phenoxybenzamine, an effective RA vasodilator in vitro, compared to the use of standard verapamil and nitrogylcerine solution in CABG patients.
Methods: Data was collected prospectively on a cohort of 697 patients who underwent CABG using a RA conduit between 1997 and 2005. Of these, 309 patients received RA grafts incubated in 2 mg/ml phenoxybenzamine for ≥ 15 minutes (P group), and 388 patients received RA grafts treated with verapamil and nitrogylcerine (VG group). Demographic, operative, and postoperative data were compared using multivariate regression analysis.
Results: Compared to patients in the VG group, P patients were older and had a greater incidence of hypertension. Vasopressor support in the early postoperative period was similar between the two groups (9% vs. 8%, P vs. VG, P=1.0). However, the incidence of perioperative myocardial events (defined as either low cardiac output syndrome or perioperative myocardial infarction) was significantly reduced in the P group (9% vs. 15%, P vs. VG, P=0.05). Perioperative myocardial enzyme release, as measured by postoperative maximum creatine kinase (CK) and troponin-T, was also significantly reduced in the P group (CK: 743.0 ± 38.8 U/l vs. 937.2 ± 63.9, P vs. VG, P=0.014). Despite adjusting for differences in demographic and operative characteristics, the use of phenoxybenzamine remained independently associated with reductions in peak postoperative CK (P=0.006) and troponin-T (P=0.08). No differences in length of stay or other complications were observed.
Conclusions: Treatment of radial artery bypass grafts with phenoxybenzamine significantly reduced perioperative myocardial injury and adverse cardiac events in this study population. These differences suggest clinical superiority of phenoxybenzamine in the prevention of RA vasospasm. Investigation to further evaluate the potential benefits of phenoxybenzamine in a randomized setting is warranted.
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