Francesco Musumeci|Mariano Feccia|Philip MacCarthy|Gethin Ellis|Laura Mammana|Frances Brinn|William Penny
Prospective randomized trial of single clamp technique versus intermittent ischaemic arrest: myocardial and neurological outcome1
University Hospital of Wales|University Hospital of Wales|University Hospital of Wales|University Hospital of Wales|University Hospital of Wales|University Hospital of Wales|University Hospital of Wales
explore hypothesis intermittent ischaemic arrest iia provides better myocardial preservation generates larger number cerebral microemboli consequently higher incidence postoperative cerebral dysfunction compared single clamp technique sctninetyone patients stable angina undergoing elective cabg clinical evidence aortic cerebrovascular neurological disease prospectively randomized iia n 43 sct intermittent anterograde cold blood cardioplegia n 48 myocardial preservation assessed measuring serum ckmb troponint tnt troponini tni pre postoperative ecgs left ventricular lv function echocardiography intraoperative cerebral counted transcranial doppler right middle cerebral artery patients completed luria nebraska neuropsychological battery lnnb tests motor visual reading memory intellectual processes day surgery 1 week 6 months postoperatively serum levels neurospecific protein s100 measuredthe two groups comparable age sex extent coronary disease previous myocardial infarction diabetes hypertension number arterial venous grafts median number detected per patient 34 range 4208 similar groups protein s100 levels remained normal similar groups times except one patient sct operative stroke lnnb scores similarly depressed 1 week recovered cases 6 months correlation number lnnb scores median peak tni levels 064 microgl iia vs 087 microgl sct p ns tnt 08 microgl vs 108 microgl p 003 sct however associated longer mean ischaemic 676 161 vs 345 165 min p 0001 mean bypass time 885 182 vs 746 263 min p 0004 iia four patients sct none iia ecg changes suggestive mi p 004during elective cabg patients clinical evidence aortic cerebrovascular disease incidence perioperative postoperative neuropsychological disturbances comparable techniques myocardial preservation biochemical analysis suggests iia provides effective myocardial preservation