HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bertolini, P. Articles by Mazzucco, A. Search for Related Content PubMed PubMed Citation Articles by Bertolini, P. Articles by Mazzucco, A.

European Journal of Cardio-Thoracic Surgery, Vol 12, 413-418, Copyright © 1997 by European Association for Cardio-thoracic Surgery

ARTICLES

Single aortic cross-clamp technique in coronary surgery: a prospective randomized study

P Bertolini, F Santini, G Montalbano, R Pessotto and A Mazzucco
Department of Cardiovascular Surgery, University of Verona Medical School, Italy.

OBJECTIVE: To test the hypothesis of an improved myocardial and cerebral protection by combining blood cardioplegia and the single aortic cross-clamp technique, 100 patients were enrolled in a prospectively randomized study and stratified for preoperative conditions. METHODS: In Group I, 55 patients underwent myocardial revascularization using crystalloid cardioplegia and the conventional partial occluding clamp technique to perform proximal anastomoses, whereas in Group II, 45 patients were operated on combining blood cardioplegia and the single aortic cross-clamp technique. Unstable angina, emergency procedures, reoperations and preoperative counterpulsation accounted for an higher risk score in group II patients (P < 0.03). Operations were performed by the same surgical team. Aortic cross-clamp time was significantly longer in group II patients (59 +/- 22 vs. 47 +/- 18 min.) (P < 0.001). Other intraoperative variables were not significant. RESULTS: A 70-year-old male in group I died on post-operative day 5 as a consequence of a major neurological event. Length of ventilatory dependency, post- operative bleeding, need for blood transfusions, ICU stay, and hospital stay were similar between the two groups (P = NS). Patients in group I showed a strict correlation between the duration of surgical ischemia and post-operative myocardial necrosis. Analysis of combined mortality and morbidity events (adverse events) between the two groups, led to a significant prevalence in group I patients (P < 0.03) in spite of an higher pre-operative risk score and longer ischemic times in group II patients. Neurological lesions remained confined to group I patients. CONCLUSIONS: The combined use of blood cardioplegia, delivered via the antegrade and retrograde routes, and the single-clamp technique to perform myocardial revascularization, might enhance myocardial and cerebral protection when compared to conventional methods. Larger groups of patients are needed to support this trend.

This article has been cited by other articles:

				S. G. Raja, M. Navaratnarajah, N. Fida, and C. S. Kitchlu For patients undergoing coronary artery bypass grafting at higher risk of stroke is the single cross-clamp technique of benefit in reducing the incidence of stroke? Interactive CardioVascular and Thoracic Surgery, June 1, 2008; 7(3): 500 - 503. [Abstract] [Full Text] [PDF]

				R. M. Mentzer Jr, R. D. Lasley, A. Jessel, and M. Karmazyn Intracellular sodium hydrogen exchange inhibition and clinical myocardial protection Ann. Thorac. Surg., February 1, 2003; 75(2): S700 - 708. [Abstract] [Full Text] [PDF]

				R. W. Kim, D. C. Mariconda, G. Tellides, G. S. Kopf, M. L. Dewar, Z. Lin, and J. A. Elefteriades Single-clamp technique does not protect against cerebrovascular accident in coronary artery bypass grafting Eur. J. Cardiothorac. Surg., July 1, 2001; 20(1): 127 - 132. [Abstract] [Full Text] [PDF]

				M. A. Borger, J. Ivanov, R. D. Weisel, V. Rao, and C. M. Peniston Stroke during coronary bypass surgery: principal role of cerebral macroemboli Eur. J. Cardiothorac. Surg., May 1, 2001; 19(5): 627 - 632. [Abstract] [Full Text] [PDF]