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 aortic manipulation. Constructing both distal and proximal anastomoses during a single period of aortic cross-clamping avoids this source of embolism and may reduce neurologic injury after coronary artery bypass grafting.


METHODS
Fifty consecutive patients undergoing coronary artery bypass grafting were prospectively randomized to group 1, in which a single aortic cross-clamping was used to construct distal and proximal anastomoses, or to group 2, in which the proximal anastomoses were each constructed with a partial occluding aortic clamp. Levels of S-100 and troponin-T release were measured preoperatively and postoperatively.


RESULTS
Aortic cross-clamp time was significantly longer in group 1, but other preoperative and intraoperative variables were equally represented in both groups. Control group levels of S-100 and troponin-T were similar. Postoperative 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 postoperative troponin-T levels.


CONCLUSIONS
The results of this trial suggest improved cerebral protection is associated with the single aortic cross-clamp technique for coronary artery bypass grafting with no increase in myocardial damage. The single aortic cross-clamp technique is simple and inexpensive. We recommend its wider use.
Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, United Kingdom.
M I
MI
Dar
T
T
Gillott
F
F
Ciulli
G J
GJ
Cooper
D000368:Aged; D003250:Constriction; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D009418:S100 Proteins / Q000096:biosynthesis*
D009418:S100 Proteins