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Single aortic cross-clamp technique in coronary surgery: a prospective randomized study
P Bertolini1, F Santini, G Montalbano
1Department of Cardiovascular Surgery, University of Verona Medical School, Italy.
Insights
Combining blood cardioplegia and a single aortic cross-clamp technique may improve myocardial and cerebral protection during heart surgery compared to conventional methods. This approach showed fewer adverse events in a randomized study.
Area of Science:
- Cardiovascular Surgery
- Neurology
Background:
- Conventional myocardial revascularization often uses crystalloid cardioplegia and partial aortic clamps.
- The efficacy of combining blood cardioplegia with a single aortic cross-clamp technique for enhanced cardiac and cerebral protection requires further investigation.
Purpose of the Study:
- To evaluate the hypothesis that combining blood cardioplegia with a single aortic cross-clamp technique improves myocardial and cerebral protection during myocardial revascularization.
- To compare the outcomes of this combined technique against conventional methods in a prospectively randomized study.
Main Methods:
- A prospectively randomized study involving 100 patients undergoing myocardial revascularization.
- Group I (n=55) received crystalloid cardioplegia and conventional partial aortic clamping.
- Group II (n=45) received blood cardioplegia combined with a single aortic cross-clamp technique, despite a higher preoperative risk score.
Main Results:
- Group II experienced significantly longer aortic cross-clamp times (59 vs. 47 min).
- Group I showed a correlation between surgical ischemia duration and myocardial necrosis, and had a significantly higher incidence of combined mortality and morbidity events (adverse events).
- Neurological lesions were exclusively observed in Group I patients.
Conclusions:
- The combined use of blood cardioplegia and single aortic cross-clamp technique may offer enhanced myocardial and cerebral protection during myocardial revascularization.
- Further research with larger patient cohorts is necessary to substantiate these findings.
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.