THE EFFECT OF THE SINGLE AORTIC CROSS-CLAMP TECHNIQUE ON CARDIAC AND CEREBRAL COMPLICATIONS DURING CORONARY-BYPASS SURGERY

Cardiac and cerebral events during coronary artery bypass graft (CABG) surgery remain a major cause of morbidity and mortality. Efforts made to reduce these events will have a significant impact on CABG results. The objective of this study was to examine our results in 394 patients undergoing primary CABG using the single clamp technique that probably has better myocardial and cerebral protective properties than the conventional technique of partial aortic occlusion. Age range was 35 to 88, mean of 66 years, and 168 (43%) were greater than or equal to 70 years of age; 121 (31%) were females, 118 (30%) were diabetic, 339 (82%) were in New York Heart Association Functional Class III or IV, 77 (20%) had a preoperative intra-aortic balloon pump, 213 (54%) were nonelective, 293 (75%) had three vessel disease, and 55 (14%) had critical left main coronary artery stenosis. Antegrade crystalloid cardioplegia was used in the majority of patients, and the distal and proximal anastomoses were sequentially constructed during a single period of total aortic occlusion. The mean number of grafts was 3.5, and 339 (86%) had greater than or equal to 3 grafts; at least one internal mammary artery was used in 346 (88%), a sequential vein or mammary artery in 181 (46%), and 55 (14%) had at least one coronary endarterectomy. The mean cross-clamp time, bypass time, and time to wean off bypass were 63, 83, and 20 minutes, respectively. The overall operative mortality was 11 of 394 (2.8%), a myocardial infarction/low-cardiac output state occurred in 19 (4.8%), and a stroke in 3 (0.8%). The total number of these events or adverse outcomes related directly to the clamping technique was 33 events in 23 patients (8.4%). The low rate of cardiac and cerebral complications associated with the single clamp technique in spite of an increased ischemia time is consistent with our previous results.