Effects of Glyceryl Trinitrate-Verapamil Solution in Comparison with Papaverine Solution by Organ Bath Technique in Preparation of Left Internal Mammary Artery for off Pump Coronary Artery Bypass Surgery

Background: Papaverine has been the conventional vasodilator used to combat vasospasm at the time of left internal mammary artery (LIMA) preparation. Recent evidence associating Papaverine with vascular wall damage in bypass conduits has prompted the search for safe and effective alternative vasodilators. A buffered vasodilator solution containing glyceryl trinitrate and verapamil solution (GV solution) made a promising vasodilator for preparation of vascular conduits. Methods: The study compared the effects and safety of GV solution to Papaverine solution on 60 patients. Group A (30 patients) received GV solution, while Group B (30 patients) received conventional Papaverine solution. The study analyzed LIMA flow before (Flow 1) and after (Flow 2) the organ bath, ICU stay, ECG, Echocardiography, mortality, morbidity, and other important parameters. Results: The administration of a vasodilator agent using the organ bath technique resulted in a significant increase in free flow (Flow 2) in both group A and group B compared to Flow 1 (p <0.0001). However, Flow 2 was significantly higher in group A than in group B (p <0.0001). There were no deaths in group A, but two deaths occurred in group B, indicating that the GV solution was safe solution. While there were lower rates of morbidity and ICU stay in group A compared to group B, these differences were not statistically significant (p >0.05). Conclusion: The GV solution was found to be a safe and effective substitute for Papaverine, preventing or rapidly reversing LIMA spasms during preparation for OPCAB surgery. Cardiovasc j 2024; 17(1): 18-23