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Topical milrinone or nitroglycerin studied for internal mammary artery flow in CABG patientsSmall study tests topical drugs on artery grafts during heart bypass surgery

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Key Takeaway
Note: No comparative efficacy data reported for topical vasodilators on LIMA flow in CABG.

This phase 3 randomized controlled trial enrolled 46 consecutive patients undergoing elective primary coronary artery bypass grafting (CABG). The study compared the topical application of milrinone (10 mg in 20 ml dextrose 5%) or nitroglycerin (10 mg in 20 ml normal saline) on the left internal mammary artery (LIMA) graft against a control of topical normal saline (0.9% sodium chloride solution).

The primary outcome was LIMA free flow, measured under controlled hemodynamic conditions before intervention (flow 1) and 12.5 minutes after topical application (flow 2). The provided evidence does not report the absolute numbers, effect sizes, p-values, or confidence intervals for the comparison between the three treatment groups. The direction of effect (whether flow increased or decreased) is also not reported.

No data on adverse events, serious adverse events, discontinuations, or tolerability were provided in the input. The study's lead sponsor was Damascus University. A key limitation is the absence of reported quantitative results, which prevents any assessment of the magnitude or statistical significance of any treatment effect. Without these comparative data, it is impossible to determine if either vasodilator was superior to saline control or to each other in increasing LIMA free flow in this surgical setting.

Researchers conducted a small, early-stage study to see if applying certain drugs directly to an artery graft during heart bypass surgery could improve blood flow. The study involved 46 patients who were having elective coronary artery bypass grafting. During surgery, a topical solution of either milrinone, nitroglycerin, or normal saline was applied to the left internal mammary artery graft, and blood flow was measured before and after application.

No specific results comparing the three groups are provided in the available information. We do not know if the drugs increased blood flow more than the saline solution, or by how much. The study also did not report any safety concerns or side effects from the topical application.

This was a small, single-measurement study with a very short follow-up of about 12 minutes. The lack of reported results means we cannot draw any conclusions about the effectiveness of the topical drugs. For patients, this means the findings are very preliminary and not ready to change surgical practice. More research with clear, reported results is needed to understand if this approach is helpful.

What this means for you:
A small study measured artery flow after topical drug application, but no comparative results are available yet.

Study Details

Study typePhase3
Sample sizen = 46
EvidenceLevel 2
Follow-up13.0 mo
PublishedMar 2026
View Original Abstract ↓
Status: COMPLETED | Phase: PHASE3 Condition(s): Internal Mammary Artery Syndrome, Vasodilation Intervention(s): The topical application of a vasodilator on the LIMA graft (DRUG) Forty-six consecutive patients undergoing elective primary coronary artery bypass grafting were enrolled. After the left IMA was harvested, free flow was measured under controlled hemodynamic conditions before any intervention (flow 1) and at a mean of 12.5 minutes after the topical application of one of three agents (milrinone, nitroglycerin or normal saline) on the IMA (flow 2). Detailed: Fifty consecutive patients undergoing elective primary coronary artery bypass grafting were enrolled in this study. Patients were randomly assigned to receive the topical application of one of three agents: milrinone (Baxter Pharmaceuticals, Ahmedabad, India) 10 mg in 20 ml of dextrose 5%, nitroglycerin (Caspian Tamin Pharmaceutical, Guilan, Iran) 10 mg in 20 ml of normal saline, or normal saline (0.9% sodium chloride solution) as control. All surgical procedures and measurements were carried out by a single surgeon who was blinded to the topical agent which was applied. Each patient enrolled in the study gave a written informed consent, and the study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki as reflected in a priori approval by the local human resear Primary Outcome(s): LIMA free flow Enrollment: 46 (ACTUAL) Lead Sponsor: Damascus University Start: 2022-01-01 | Primary Completion: 2023-01-31
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