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Introducing sequential partial aortic clamp technique for proximal anastomoses and its advantages in myocardial
Reza Khajeh1, Khalil Zarrabi1, Maryam Ouhadian2
1Department of Cardiac Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
Insights
A new sequential partial aortic clamp technique for coronary artery bypass grafting (CABG) reduces myocardial injury and postoperative atrial fibrillation compared to the standard partial aortic clamp method.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Vascular Surgery
Background:
- Ischemic heart disease (IHD) necessitates surgical intervention like coronary artery bypass grafting (CABG).
- Proximal anastomoses are critical steps in CABG, with standard techniques potentially causing myocardial injury.
- Optimizing aortic clamping strategies is essential for improving CABG outcomes.
Purpose of the Study:
- To introduce and evaluate a novel sequential partial aortic clamp technique for proximal anastomoses in CABG.
- To compare the incidence of myocardial injury and postoperative atrial fibrillation between the novel and standard clamping techniques.
Main Methods:
- A clinical trial involving 29 cases and 29 matched controls undergoing CABG.
- Cases received the sequential partial aortic clamp technique; controls received the standard partial aortic clamp.
- Data collected from June 2014 to June 2023, analyzing cardiac enzyme levels and postoperative atrial fibrillation rates.
Main Results:
- The sequential partial aortic clamp technique resulted in significantly lower CK-MB levels (p < 0.001).
- No statistically significant difference in cTnI levels was observed between the groups (p = 0.05).
- Postoperative atrial fibrillation occurred in 10.3% of cases versus 41.4% of controls (p = 0.007).
Conclusions:
- The sequential partial aortic clamp technique demonstrates reduced myocardial injury compared to the standard partial aortic clamp.
- This novel technique is associated with a lower incidence of postoperative atrial fibrillation in CABG patients.
Abstract:
Ischemic heart disease (IHD) is a common and potentially lethal cardiovascular disorder. Coronary artery bypass grafting (CABG) is a standard procedure for treating IHD. This study aims to introduce a novel technique for proximal anastomoses in CABG. This clinical trial studied 29 cases and 29 matched controls. Data were gathered from June 2014 to June 2023. Regarding proximal anastomoses, the sequential partial aortic clamp was performed in cases, and the partial aortic clamp was done for controls. In the sequential partial aortic clamp technique, a relatively small or medium vascular clamp was used instead of one clamp for all proximal anastomoses, which closed a small amount of the aortic wall at each stage. At each stage, only one hole in the aortic wall and only one anastomosis between the conduit and the aorta was performed. After the end of each anastomosis, the clamp was opened and placed on another part of the aorta, and the next anastomosis was performed. CK-MB (p < 0.001, Eta Squared = 0.255) level was significantly lower in cases that underwent sequential partial ascending aorta clamping. However, cTnI level was not statistically different among cases and controls(p = 0.05). Of all patients, 3 (10.3%) cases and 12 (41.4%) controls developed with postoperative atrial fibrillation (p = 0.007). The sequential partial aortic clamp technique leads to less myocardial injury than the partial aortic clamp technique. Also, patients undergoing sequential partial aortic clamp technique are less likely to develop postoperative atrial fibrillation.
