SINGLE AORTIC CROSS-CLAMP TECHNIQUE IN CORONARY SURGERY - A PROSPECTIVE RANDOMIZED STUDY

Objective: To test the hypothesis of an improved myocardial and cerebr al protection by combining blood cardioplegia and the single aortic cr oss-clamp technique, 100 patients were enrolled in a prospectively ran domized study and stratified for preoperative conditions. Methods: In Group I, 55 patients underwent myocardial revascularization using crys talloid cardioplegia and the conventional partial occluding clamp tech nique to perform proximal anastomoses, whereas in Group II, 45 patient s were operated on combining blood cardioplegia and the single aortic cross-clamp technique. Unstable angina, emergency procedures, reoperat ions and preoperative counterpulsation accounted for an higher risk sc ore in group II patients (P < 0.03). Operations were performed by the same surgical team. Aortic cross-clamp time was significantly longer i n 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 maj or neurological event. Length of ventilatory dependency, post-operativ e bleeding, need for blood transfusions, ICU stay, and hospital stay w ere similar between the two groups (P = NS). Patients in group I showe d a strict correlation between the duration of surgical ischemia and p ost-operative myocardial necrosis. Analysis of combined mortality and morbidity events (adverse events) between the two groups, led to a sig nificant prevalence in group I patients (P < 0.03) in spite of an high er pre-operative risk score and longer iscaemic times in group II pati ents. Neurological lesions remained confined to group I patients. Conc lusions: The combined use of blood cardioplegia, delivered via the ant egrade and retrograde routes, and the single-clamp technique to perfor m myocardial revascularization, might enhance myocardial and cerebral protection when compared to conventional methods. Larger groups of pat ients are needed to support this trend. (C) 1997 Elsevier Science B.V.