Key result
Single aortic cross-clamping during CABG had longer cross-clamp times (65 vs 49 min, P=0.0001) but lower postoperative CK-MB and hsTnI levels at 24 and 48 hours than double clamping.
Why the study?
The study was conducted to compare the effects of two aortic clamping strategies for constructing proximal aortocoronary anastomoses on myocardial protection and postoperative outcomes during CABG.
Does a single aortic cross-clamp strategy improve myocardial protection compared to a double clamp strategy in patients undergoing CABG for triple vessel CAD?
Cohort (n=200)
Does a single aortic cross-clamp strategy improve myocardial protection compared to a double clamp strategy in patients undergoing CABG for triple vessel CAD?
A single aortic cross-clamp strategy for proximal anastomoses during CABG provides better myocardial protection, as evidenced by lower postoperative cardiac biomarker release, compared to a double clamp strategy.
Single clamp technique was associated with lower biomarkers after CABG; leaves open whether it improves clinical outcomes pending randomized trials.
BACKGROUND: The purpose of the present study was to compare the effects of two different clamping strategies for the construction of the proximal aortocoronary anastomoses on myocardial protection and postoperative outcomes during coronary artery bypass grafting (CABG) operations. METHODS: In this retrospective study, we examined prospectively collected data of patients who underwent CABG for a 3-year period. Two hundred consecutive patients, who were diagnosed with triple vessel coronary artery disease (CAD), were selected and divided into two groups. In Group 1 (single clamp) (N = 100), venoaortic proximal anastomoses were performed using a single aortic cross-clamp, while in Group 2 (double clamp) (N = 100), proximal anastomoses were performed by using an aortic side clamp. Operative and postoperative outcomes of the patients were compared between the two groups. The serum levels of myocardial damage biomarkers, creatine phosphokinase-MB (CPK-MB), and high sensitive Troponin (hsTnI) results were measured preoperatively, intraoperatively, and postoperatively (6, 12, 24, and 48 hours). RESULTS: Patient demographics and characteristics were similar between the two groups. In Group 1, cross-clamp duration time (65 min versus 49 min; P = .0001) was longer. However, perfusion time (91 min versus 85 min; P = .61) was similar between the two groups. In Group 2, postoperative CK-MB levels were significantly higher intraoperatively (P = .18), 6 hours (P = .22), 24 hours (P = .001), and 48 hours (P = .001) than in Group 1. HsTnI was only significantly higher in Group 2 versus Group 1 at 24 hours (P = .001) and 48 hours (P = .01) postoperatively. Time of intensive care unit stay, duration of extubation, and length of hospital stay were similar in both groups. CONCLUSION: The technique used for proximal anastomosis has a significant effect on perioperative results, especially on myocardial protection.
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Eriş et al. (2021) conducted a cohort in Triple vessel coronary artery disease (CAD) (n=200). Single aortic cross-clamp vs. Aortic side clamp (double clamp) was evaluated on Myocardial protection (CK-MB and hsTnI levels) and postoperative outcomes. Single aortic cross-clamping during CABG had longer cross-clamp times (65 vs 49 min, P=0.0001) but lower postoperative CK-MB and hsTnI levels at 24 and 48 hours than double clamping.
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