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(Chest. 2005;128:3065-3073.)
© 2005 American College of Chest Physicians

The Potential Use of Type-5 Phosphodiesterase Inhibitors in Coronary Artery Bypass Graft Surgery*

Erik Fung, MB, ChB; Ronald R. Fiscus, PhD; Anthony P. C. Yim, DM, FRCS, FCCP; Gianni D. Angelini, MD, FRCS and Ahmed A. Arifi, MD, FRCS

* From the Division of Cardiothoracic Surgery (Drs. Fung, Yim, and Arifi), Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong, China; Department of Physiology, Faculty of Medicine (Dr. Fiscus), The Chinese University of Hong Kong, Shatin, Hong Kong, China; and Bristol Heart Institute (Dr. Angelini), University of Bristol, Bristol, UK.

Correspondence to: Ahmed A. Arifi, MD, FRCS, Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China; e-mail: arifi64{at}surgery.cuhk.edu.hk

Abstract

Exaggerated vasospasm, platelet activation, and early graft occlusion are significant barriers to successful coronary artery bypass grafting (CABG). Interestingly, vascular smooth muscle and platelets are predominant sources of type-5 phosphodiesterase (PDE5) in the body, and this enzyme is specifically inhibited by PDE5 inhibitors (eg, sildenafil citrate). Together with endogenous nitric oxide, sildenafil can induce pulmonary and coronary vasodilation, precondition the myocardium, reduce platelet activation, and potentially reduce early graft occlusion. Currently, there are no published clinical trials investigating sildenafil in coronary surgery. Recent studies on the potential use of sildenafil strongly support its beneficial effects in a wide range of patients with cardiovascular diseases. Therefore, we sought to review the literature, explore the current hypothesis that the use of sildenafil in coronary surgery patients can be beneficial, and attempt to define its potential place in the setting of CABG.

Key Words: coronary artery bypass grafting • phosphodiesterase • sildenafil






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