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The Annals of Thoracic Surgery, Vol 58, 296-302, Copyright © 1994 by The Society of Thoracic Surgeons
SF Aranki, RJ Rizzo, DH Adams, GS Couper, NM Kinchla, JS Gildea and LH Cohn
To determine the myocardial and cerebral protective properties of the
single cross-clamp (group I; n = 160) versus the partial occluding clamp
(group II; n = 150) technique for construction of the proximal anastomoses,
a retrospective analysis of 310 patients operated on by the same surgeon
was performed. Group I patients were older (median age, 70 versus 64 years;
p < or = 0.0001), with 83 (52%), versus 41 (27%) in group II, 70 years
and older (p < or = 0.0001). More group I patients were in New York
Heart Association functional class IV (42 [26%] versus 22 [15%]; p =
0.008); more required preoperative balloon counterpulsation (35 [22%]
versus 16 [11%]; p = 0.006); and more required emergent operation (20 [13%]
versus 3 [2%]; p < or = 0.0001). Antegrade crystalloid cardioplegia was
used in both groups. The median cross-clamp time was 58 minutes for group I
versus 44 minutes for group II (p < or = 0.0001). However, there was no
significant difference between the two groups in terms of the number of
bypass grafts, the use of the mammary artery, or the bypass time. The
operative mortality was 2.5% (n = 4) for group I versus 5.3% (n = 8) for
group II (p = 0.16), and the perioperative myocardial infarction/low
cardiac output state was seen in 6 patients (3.8%) in group I versus 18
patients (12%) in group II (p = 0.006). The median creatine kinase MB
release was 13 U/L for group I versus 19 U/L for group II (p =
0.0029).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Single-clamp technique: an important adjunct to myocardial and cerebral protection in coronary operations
Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115.
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