Single aortic cross-clamping for distal and proximal anastomoses in coronary surgery: an alternative to conventional techniques.

Using hypothermic cardiopulmonary bypass and a single cross-clamping period under multidose infusions of hypothermic cardioplegia, both distal and proximal anastomoses were performed in 87 consecutive patients undergoing coronary artery operation. This method allows for precise surgical technique, avoids the need for multiple clampings of the ascending aorta, and appears to avoid the threat of aortic tear. When the clamp is released, the heart has been totally revascularized. This is in contrast to more conventional methods, where an exclusion clamp is applied to the ascending aorta and where the combination of coronary stenosis, low perfusion pressure during bypass, and narrowing of the ascending aorta by the exclusion clamp may be more hazardous than a single cross-clamp period for construction of all anastomoses. This is particularly applicable to patients with severe stenosis of the left main coronary artery.