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Reduction of microembolic signals with a single-clamp strategy in coronary artery bypass surgery: a pilot study
Hrvoje Gasparović1, Branko Malojcić, Marko Borojević
1Department of Cardiac Surgery, University Hospital Rebro Zagreb, Kispaticeva 12, 10 000 Zagreb, Croatia. hgasparovic@kbc-zagreb.hr
Insights
The single aortic clamp technique in coronary artery bypass grafting (CABG) reduces microembolic signals (MES) and improves postoperative neurocognitive function compared to conventional methods.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Medical Technology
Background:
- Neurologic deficits are a significant concern following cardiac surgery.
- Aortic manipulation during surgery can cause emboli, leading to neurocognitive injury.
- The single aortic clamp (SC) technique aims to minimize aortic manipulation during coronary artery bypass grafting (CABG).
Purpose of the Study:
- To evaluate the impact of the single aortic clamp (SC) strategy versus conventional multiple aortic side-clamp (MC) technique on cerebral embolism.
- To assess the effect of these techniques on neurocognitive outcomes after CABG.
- To test the hypothesis that SC technique reduces microembolic signals (MES).
Main Methods:
- A prospective pilot study involving 22 patients undergoing CABG.
- Patients were divided into two groups: single aortic clamp (SC) and multiple aortic side-clamp (MC).
- Cerebral embolism was monitored using transcranial Doppler (TCD) to detect microembolic signals (MES). Neurocognitive function was assessed using the mini-mental state examination (MMSE).
Main Results:
- The SC group exhibited significantly fewer MES (72 ± 28) compared to the MC group (127 ± 69; P = .02).
- Postoperative neurocognitive performance, measured by MMSE, showed a less pronounced reduction in the SC group (25.3 ± 1.6) than in the MC group (22.2 ± 4.1; P = .02).
- No deaths or perioperative myocardial infarctions occurred in either group. One patient in the MC group experienced a reversible ischemic neurologic deficit.
Conclusions:
- The single-clamp CABG strategy is associated with a reduced embolic burden, as indicated by lower MES.
- This technique translates to better neurocognitive performance following cardiac surgery compared to conventional methods.
- The SC technique represents a promising approach to mitigate neurologic complications in CABG patients.
Background:
Neurologic deficits are perhaps the most feared form of adverse outcome following cardiac surgery. Aortic trauma generates emboli and hence harbors the potential for neurocognitive injury. The single aortic clamp strategy of coronary artery bypass grafting (CABG) aims at reducing aortic manipulation. We hypothesized that this strategy will lead to a reduction in the number microembolic signals (MES) evaluated by transcranial Doppler (TCD), a surrogate measure of cerebral embolism.
Methods:
This pilot study was based on a prospective analysis of 22 patients in whom CABG was performed either with a single aortic clamp (SC group) or with a conventional multiple aortic side-clamp technique (MC group). The 2 groups did not differ with respect to mean age (60 + or - 6 years versus 65 + or - 8 years, not statistically significant [NS]) or EuroSCORE (2.1 + or - 1.5 versus 2.9 + or - 2, P = NS). The neurocognitive evaluation was based on the mini-mental state examination (MMSE). The preoperative MMSE values for the SC and MC groups were similar (29.5 + or - 0.5 and 29.2 + or - 1, respectively; P = NS).
Results:
The total number of solid-particle embolization signals secondary to aortic manipulation was lower in the SC group than in the MC group (72 + or - 28 versus 127 + or - 69, P = .02). Neurocognitive performance was moderately reduced in both groups compared with preoperative values. This reduction was more pronounced in the MC group than in the SC group (22.2 + or - 4.1 versus 25.3 + or - 1.6, P = .02). One patient in the MC group had a reversible ischemic neurologic deficit (P = NS). There were no deaths or perioperative myocardial infarctions in either group.
Conclusions:
The single-clamp CABG strategy led to a reduction in MES, indicating a less pronounced embolic burden than with the conventional side-clamp CABG strategy. This strategy translated into a better performance in postoperative neurocognitive testing in the SC group of patients.
