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Ann Thorac Surg 1997;64:1742-1746
© 1997 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Effect of Low-Dose Positive Inotropic Drugs on Human Internal Mammary Artery Flow

Jean-Luc Cracowski, MD, Olivier Chavanon, MD, Michel Durand, MD, Elisabeth Borrel, MD, Philippe Devillier, MD, PhD, Jean-Michel Mallion, MD, Dominique Blin, MD

Pharmacology Laboratory and Departments of Cardiac Surgery, Internal Medicine, and Cardiology, Grenoble University Hospital, Grenoble, France

Accepted for publication June 29, 1997.

Background. Dobutamine (a ß-receptor agonist), enoximone (a type III selective phosphodiesterase inhibitor), and epinephrine (an {alpha}- and ß-mimetic) frequently are used in the perioperative management of patients undergoing coronary artery bypass grafting.

Methods. We performed a double-blind clinical study to compare the effects on internal mammary artery free flow of low doses of these three positive inotropic drugs. Thirty patients in whom the left internal mammary artery was used for coronary artery bypass grafting were randomized into three groups. Internal mammary artery free flow and hemodynamic measurements were evaluated before and 10 minutes after the intravenous infusion of dobutamine (3 µg • kg-1 • min-1), enoximone (200 µg/kg), or epinephrine (0.05 µg • kg-1 • min-1).

Results. A significant increase in free flow occurred only in the dobutamine group (33 ± 7.5 and 42.2 ± 7.9 mL/min before and after drug infusion, respectively; p = 0.013). Comparison of the increase in flow between the groups, however, showed no difference. These drugs, at doses designed to produce a positive inotropic effect, caused little increase in the free flow of the internal mammary artery.

Conclusions. The use of dobutamine, enoximone, and epinephrine as low-dose positive inotropic treatments in the perioperative and postoperative periods of coronary artery bypass grafting should depend on their positive inotropic effects rather than their vasodilative effects on the arterial grafts.


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Invited Commentary
Brian Buxton
Ann. Thorac. Surg. 1997 64: 1746. [Extract] [Full Text]





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