Single aortic cross-clamp technique reduces S-100 release after coronary artery surgery

Background. Neurologic impairment after coronary artery bypass grafting is associated with cerebral embolization. An important cause of embolism is ao rtic manipulation. Constructing both distal and proximal anastomoses during a single period of aortic crossclamping avoids this source of embolism and may reduce neurologic injury after coronary artery bypass grafting. Methods. Fifty consecutive patients undergoing coronary artery bypass graft ing were prospectively randomized to group 1, in which a single aortic cros s-clamping tvas used to construct distal and proximal anastomoses, or to gr oup 2, in which the proximal anastomoses were each constructed with a parti al occluding aortic clamp. Levels of S-100 and troponin-T release were meas ured preoperatively and postoperatively. Results. Aortic cross-clamp time was significantly longer in group 1, but o ther preoperative and intraoperative variables were equally represented in both groups. Control group levels of S-100 and troponin-T were similar. Pos toperative 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 pos toperative troponin-T levels. Conclusions. The results of this trial suggest improved cerebral protection is associated with the single aortic cross-clamp technique for coronary ar tery bypass grafting with no increase in myocardial damage. The single aort ic cross-clamp technique is simple and inexpensive. We recommend its wider use. (C) 2001 by The Society of Thoracic Surgeons.