Skip to main content
SpringerLink
Log in

Botulinum Toxin Treatment in Cardiovascular Surgery

  • Chapter
  • First Online:
Botulinum Toxin Treatment in Surgery, Dentistry, and Veterinary Medicine

Abstract

Although the use of Botulinum Toxin (BTX) is a common practice especially in cosmetics, plastic and ophthalmic surgery over the last four decades, cardiac and vascular use is relatively new. The new articles published and ongoing studies for cardiovascular use are promising. Although the basic data and researches performed so far are rather limited, cardiac use can be sampled as suppression of postoperative rhythm, especially atrial fibrillation. Vascular use of BTX is mainly investigated for prevention of arterial spasm, mainly in graft patencies, or native arteries. BTX-A might be considered as an alternative topical agent for prevention of arterial graft spasms (Internal mammarian and radial artery) in coronary artery bypass graft surgery. Its effectiveness was also documented in different studies, involving the functional popliteal artery entrapment syndrome and vasospastic disorders, including Raynaud’s phenomenon. With the highlights of recent articles gathered and our experience, this chapter briefly identifies the experimental and clinical use of BTX in cardiovascular area.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Lamanna C, el-Hage AN, Vick JA. Cardiac effects of botulinal toxin. Arch Int Pharmacodyn Ther. 1998;293:69–83.

    Google Scholar 

  2. Carlson MD, Geha AS, Hsu J, Martin PJ, Levy MN, Jacobs G, et al. Selective stimulation of parasympathetic nerve fibers to the human sinoatrial node. Circulation. 1992;85:1311–7.

    Article  CAS  PubMed  Google Scholar 

  3. Furukawa Y, Wallick DW, Carlson MD, Martin PJ. Cardiac electrical responses to vagal stimulation of fibers to discrete cardiac regions. Am J Physiol. 1990;258:1112–8.

    Google Scholar 

  4. Tsuibo M, Furukawa Y, Kurogouchi F, Nakajima K, Hirose M, Chiba S. Botulinum neurotoxin A blocks cholinergic ganglionic neurotransmission in the dog heart. Jpn J Pharmacol. 2002;89:249–54.

    Article  Google Scholar 

  5. Nisanoglu V, Erdil N, Aldemir M, Ozgur B, BeratCihan H, Yologlu S, et al. Atrial fibrillation after coronary artery bypass grafting in elderly patients: incidence and risk factor analysis. Thorac Cardiovasc Surg. 2007;55:32–8.

    Article  CAS  PubMed  Google Scholar 

  6. Ahlsson A, Bodin L, Fengsrud E, Englund A. Patients with postoperative atrial fibrillation have a doubled cardiovascular mortality. Scand Cardiovasc J. 2009;43:330–6.

    Article  PubMed  Google Scholar 

  7. Eckardt L, Hausler KG, Ravens U, Borggrefe M, Kirchof P. ESC guidelines on atrial fibrillation: summary of the most relevant recommendations and modifications. Herz. 2016;41:677–83.

    Article  CAS  PubMed  Google Scholar 

  8. Andrade JG, Macle L, Nattel S, Verma A, Caims J. Contemporary atrial fibrillation management: a comparison of the current AHA/ACC/HRS, CCS, and ESC guidelines. Can J Cardiol. 2017;33:965–76.

    Article  PubMed  Google Scholar 

  9. Amar D, Zhang H, Miodownik S, Kadish AH. Competing autonomic mechanisms precede the onset of postoperative atrial fibrillation. J Am Coll Cardiol. 2003;42:1262–8.

    Article  PubMed  Google Scholar 

  10. Pokushalov E, Kozlov B, Romanov A, Strelniov A, Bayramova S, Sergeevichev D, et al. Long-term suppression of atrial fibrillation by botulinum toxin injection into epicardial fat pads in patients undergoing cardiac surgery: one-year follow up of a randomized pilot study. Circ Arrhythm Electrophysiol. 2015;8:1334–41.

    Article  CAS  PubMed  Google Scholar 

  11. Romanov A, Pokushalov E, Ponomarev D, Bayramova S, Shabanov V, Losik D, et al. Long-term suppression of atrial fibrillation by botulinum toxin injection into epicardial fat pads in patients undergoing cardiac surgery: three-year follow up of a randomized study. Heart Rhythm. 2019;16:172–7.

    Article  PubMed  Google Scholar 

  12. Waldron NH, Cooter M, Haney JC, Schroder JN, Gaca JG, Lin SS, et al. Temporary autonomic modulation with botulinum toxin type A to reduce atrial fibrillation after cardiac surgery. Heart Rhythm. 2019;16:178–84.

    Article  PubMed  Google Scholar 

  13. Fatahian A. Botulinum toxin injection into epicardial fat pads: a promising potential modality for prevention of postoperative atrial fibrillation after cardiac surgery. Braz J Cardiovasc Surg. 2019;34:643.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Rosenfeldt FL, He GW, Buxton BF, Angus JA. Pharmacology of coronary artery bypass. Ann Thorac Surg. 1999;67:878–88.

    Article  CAS  PubMed  Google Scholar 

  15. Murakami E, Iwata H, Imaizumi M, Takemura H. Prevention of arterial graft spasm by botulinum toxin: an in-vitro experiment. Interact Cardiovasc Thorac Surg. 2009;9:395–8.

    Article  PubMed  Google Scholar 

  16. Hayashi M, Shimizu Y, Sato M, Yokoyama T, Yosimoto S. Changes in the blood flow of the femoral artery by botulinum toxin in rats. Ann Plast Surg. 2014;73:98–101.

    Article  CAS  PubMed  Google Scholar 

  17. Tanyeli O, Duman I, Dereli Y, Gormus N, Toy H, SAhin AS. Relaxation matters: comparison of in-vitro vasodilatory role of botulinum toxin-A and papaverine in human radial artery grafts. J Cardiothorac Surg. 2019;14:15.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Duman I, Tanyeli O, Dereli Y, Oltulu P, Toy H, Sahin AS. Effects of botulinum toxin A and papaverine in preventing spasm of human saphenous vein and internal mammary artery grafts: an in vitro study. 67th International Congress of the European Society of Cardiovascular and Endovascular Surgery, Strasbourg, France. J Cardiovasc Surg. 2018;59(Suppl 2):21–2.

    Google Scholar 

  19. Nahabedian MY, Momen B, Manson PN. Factors associated with anastomotic failure after microvascular reconstruction of the breast. Plast Reconstr Surg. 2004;114:74–82.

    Article  PubMed  Google Scholar 

  20. Clemens MW, Higgins JP, Shaw Wilgis EF. Prevention of anastomotic thrombosis by botulinum toxin A in an animal model. Plast Reconstr Surg. 2009;123:64–70.

    Article  CAS  PubMed  Google Scholar 

  21. Janz BA, Thomas PR, Fanua SP, Dunn RE, Wilgis EF, Means KR Jr. Prevention of anastomotic thrombosis by botulinum toxin B after acute injury in a rat model. J Hand Surg Am. 2011;36:1585–91.

    Article  PubMed  Google Scholar 

  22. Di Marzo L, Cavallaro A. Popliteal vascular entrapment. World J Surg. 2005;29:43–5.

    Article  Google Scholar 

  23. Turnipseed WD. Popliteal entrapment in runners. Clin Sport Med. 2012;31:321–8.

    Article  Google Scholar 

  24. Pillai J. A current interpretation of popliteal vascular entrapment. J Vasc Surg. 2008;48:61–5.

    Article  Google Scholar 

  25. Shahi N, Arosemena M, Kwon J, Abai B, Salvatore D, diMuzio P. Functional popliteal artery entrapment syndrome: a review of diagnosis and management. Ann Vasc Surg. 2019;59:259–67.

    Article  PubMed  Google Scholar 

  26. Turnipseed WD. Functional popliteal artery entrapment syndrome: a poorly understood and often missed diagnosis that is frequently mistreated. J Vasc Surg. 2009;49:1189–95.

    Article  PubMed  Google Scholar 

  27. Hislop M, Kennedy D, Cramp B, Dhupelia S. Functional popliteal artery entrapment syndrome: poorly understood and frequently missed? A review of clinical features, appropriate investigations, and treatment options. J Sports Med. 2014;2014:105953.

    Article  Google Scholar 

  28. Gandor F, Tisch S, Grabs AJ, Delaney AJ, Bester L, Darveniza P. Botulinum toxin A in functional popliteal entrapment syndrome: a new approach to a difficult diagnosis. J Neural Transm. 2014;121:1297–301.

    Article  CAS  PubMed  Google Scholar 

  29. Hislop M, Brideaux A, Dhupelia S. Functional popliteal artery entrapment syndrome: use of ultrasound guided Botox injection as a non-surgical treatment option. Skelet Radiol. 2017;46:1241–8.

    Article  Google Scholar 

  30. Neumeister MW, Chambers CB, Herron MS, Webb K, Wietfeldt J, Gillespie JN, et al. Botox therapy for ischemic digits. Plast Reconstr Surg. 2009;124:191–200.

    Article  CAS  PubMed  Google Scholar 

  31. Herrick AL. Pathogenesis of Raynaud’s phenomenon. Rheumatology. 2005;44:587–96.

    Article  CAS  PubMed  Google Scholar 

  32. Thompson AE, Pope JE. Calcium channel blockers for primary Raynaud’s phenomenon: a meta-analysis. Rheumatology. 2005;44:145–50.

    Article  CAS  PubMed  Google Scholar 

  33. Matucci-Cerinic M, Denton CP, Frust DE, Mayes MD, Hsu VM, Carpentier P, et al. Bosentan treatment of digital ulcers related to systemic sclerosis. Results from RAPIDS-2 randomised, double-blind placebo-controlled trial. Ann Rheum Dis. 2011;70:32–8.

    Article  CAS  PubMed  Google Scholar 

  34. Wigley FM, Wise RA, Seibold JR, McCloskey DA, Kujala G, Medsger TA Jr, et al. Intravenous iloprost infusion in patients with Raynaud phenomenon secondary to systemic sclerosis. A multicentric placebo-controlled, double-blind study. Ann Intern Med. 1994;120:199–206.

    Article  CAS  PubMed  Google Scholar 

  35. Nguyen VA, Eisendle K, Gruber I, Hughe B, Reider D, Reider N. Effect of the dual endothelin receptor antagonist bosentan on Raynaud’s phenomenon secondary to systemic sclerosis: a double-blind prospective, randomized, placebo-controlled pilot study. Rheumatology. 2010;49:583–7.

    Article  CAS  PubMed  Google Scholar 

  36. Uroskie J, Schmidt C, Baratz MF. Vascular disorders of the hand and upper extremity. In: Beredjiklian P, Bozentka DJ, editors. Review of hand surgery. Philadelphia: Saunders; 2004. p. 63–78.

    Google Scholar 

  37. Sycha T, Graninger M, Auff E, Schnider P. Botulinum toxin in the treatment of Raynaud’s phenomenon: a pilot study. Eur J Clin Investig. 2004;34:312–3.

    Article  CAS  Google Scholar 

  38. Van Beek AL, Lim PK, Gear AJL, Marc RP. Management of vasospastic disorders with botulinum toxin A. Plast Reconstr Surg. 2007;119:217–26.

    Article  PubMed  CAS  Google Scholar 

  39. Fregene A, Ditmars D, Siddiqui A. Botulinum toxin type A: a treatment option for digital ischemia in patients with Raynaud’s phenomenon. J Hand Surg. 2009;34:446–52.

    Article  Google Scholar 

  40. Medina S, Zubiaur AG, Casillas NV, Rodriguez IP, Ruiz L, Izquierdo C, et al. Botulinum toxin type A in the treatment of Raynaud’s phenomenon: a three-year follow-up study. Eur J Rheumatol. 2018;5:224–9.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Weum S, Weerd L. Ultrasound -guided sympathetic block of the radial artery with botulinum toxin to treat vasospasm. Plast Reconstr Surg Glob Open. 2018;6:e1836.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Danielson K, Odderson IR. Botulinum toxin type A improves blood flow in vascular thoracic outlet syndrome. Am J Phys Med Rehabil. 2008;87(11):956–9.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

We thank Ipek Duman, MD, for her collaboration in our previous studies performed by botulinum toxin and Niyazi Gormus, MD, Prof. Dr., chief of our clinic, for his endless support in our clinical and scientific studies.

Author information

Authors and Affiliations

  1. Meram Medicine Faculty, Department of Cardiovascular Surgery, Necmettin Erbakan University, Konya, Turkey

    Omer Tanyeli & Mehmet Isik

Authors
  1. Omer Tanyeli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mehmet Isik
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Professor Emeritus of Neurology, Yale University School of Medicine, New Haven, CT, USA

    Bahman Jabbari

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Tanyeli, O., Isik, M. (2020). Botulinum Toxin Treatment in Cardiovascular Surgery. In: Jabbari, B. (eds) Botulinum Toxin Treatment in Surgery, Dentistry, and Veterinary Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-50691-9_7

Download citation

Publish with us

Policies and ethics

Search

Navigation