Can We Make the Gold Standard Better?

Coronary artery bypass grafting (CABG) has provided tremendous benefit to millions of patients. This benefit depends on the ability to provide a durable increase in blood supply to the myocardium through arterial and venous conduits. The greatest value arises from the use of internal thoracic artery (ITA) grafts, which have been shown to offer the highest patency rates and the maximal increase in survival in selected patient populations. But ITA grafts are not free of complications, and some patients will experience early or delayed graft occlusion related to technical imperfections, poor-quality runoff, endothelial damage, or perioperative spasm. Spasm in ITA grafts, while not common, can have serious sequelae ranging from early myocardial ischemia to graft failure that can eliminate the long-term benefits of ITA grafting. Antispastic Effect of Fasudil and Cocktail of Fasudil and Nitroglycerin in Internal Thoracic ArteryThe Annals of Thoracic SurgeryVol. 115Issue 5PreviewSpasm of arterial grafts in coronary artery bypass grafting is a clinical problem and can occasionally be lethal. Perioperative spasm in the internal thoracic artery (ITA) and coronary arteries occurs in 0.43% of patients. This study aimed to investigate the antispastic effect of a RhoA/Rho-kinase (Rho-associated coiled-coil-containing protein kinase [ROCK]) inhibitor (fasudil) with and without nitroglycerin in combination in the ITA. Full-Text PDF