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Published on: September 25, 2017
Single aortic cross-clamp technique reduces S-100 release after coronary artery surgery
1Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, United Kingdom.
Insights
This study found that a single aortic cross-clamp technique during coronary artery bypass grafting (CABG) improves cerebral protection. This method reduces neurologic injury without increasing myocardial damage, suggesting wider adoption for safer CABG procedures.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Anesthesiology
Background:
- Neurologic impairment following coronary artery bypass grafting (CABG) is often linked to cerebral embolization.
- Aortic manipulation during surgery is a significant contributor to this embolic event.
- A single aortic cross-clamping technique may mitigate this risk by minimizing aortic manipulation.
Purpose of the Study:
- To evaluate the effectiveness of a single aortic cross-clamp technique in preventing neurologic injury during CABG.
- To compare cerebral protection strategies between single and multiple aortic cross-clamp methods.
- To assess the impact of the single aortic cross-clamp technique on myocardial damage markers.
Main Methods:
- Fifty patients undergoing CABG were prospectively randomized into two groups.
- Group 1 utilized a single aortic cross-clamp for both distal and proximal anastomoses.
- Group 2 employed partial aortic clamps for proximal anastomoses; S-100 and troponin-T levels were monitored.
Main Results:
- While aortic cross-clamp time was longer in the single-clamp group, other patient variables were comparable.
- Postoperative S-100 levels, a marker of brain injury, were significantly lower in the single-clamp group (p < 0.015).
- No significant differences in postoperative troponin-T levels, indicating myocardial damage, were observed between groups.
Conclusions:
- The single aortic cross-clamp technique offers enhanced cerebral protection during CABG.
- This method does not increase the risk of myocardial damage.
- The technique is simple, cost-effective, and recommended for broader clinical application.
Background:
Neurologic impairment after coronary artery bypass grafting is associated with cerebral embolization. An important cause of embolism is aortic manipulation. Constructing both distal and proximal anastomoses during a single period of aortic cross-clamping avoids this source of embolism and may reduce neurologic injury after coronary artery bypass grafting.
Methods:
Fifty consecutive patients undergoing coronary artery bypass grafting were prospectively randomized to group 1, in which a single aortic cross-clamping was used to construct distal and proximal anastomoses, or to group 2, in which the proximal anastomoses were each constructed with a partial occluding aortic clamp. Levels of S-100 and troponin-T release were measured preoperatively and postoperatively.
Results:
Aortic cross-clamp time was significantly longer in group 1, but other preoperative and intraoperative variables were equally represented in both groups. Control group levels of S-100 and troponin-T were similar. Postoperative S-100 levels were significantly higher in group 2 than in group 1 (p < 0.015). No significant difference was found between the groups in postoperative troponin-T levels.
Conclusions:
The results of this trial suggest improved cerebral protection is associated with the single aortic cross-clamp technique for coronary artery bypass grafting with no increase in myocardial damage. The single aortic cross-clamp technique is simple and inexpensive. We recommend its wider use.
