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Eur J Cardiothorac Surg 2001;20:127-132
© 2001 Elsevier Science NL

Single-clamp technique does not protect against cerebrovascular accident in coronary artery bypass grafting

^a Department of Surgery, Section of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, CT 06510, USA
^b Center for Outcomes Research, Yale–New Haven Hospital, New Haven, CT 06510, USA

Received 11 December 2000; received in revised form 10 April 2001; accepted 23 April 2001.

Corresponding author. Tel.: +1-203-785-2705; fax: +1-203-785-3346
e-mail: john.elefteriades{at}yale.edu

Objectives: By potentially avoiding the embolic consequences of a side-biting aortic clamp, the single-clamp technique may decrease cerebrovascular accidents in coronary artery bypass grafting. However, this theoretical superiority in stroke prevention has not been conclusively demonstrated and use of this technique may lead to adverse myocardial effects due to longer cross-clamp times. In this study, we sought to determine if the single-clamp technique prevents postoperative stroke in clinical practice. Methods: Of 607 consecutive isolated coronary bypass operations completed over a 3 year period, 301 (50%) were performed by one surgeon using exclusively the single-clamp technique and 306 (50%) were performed by a second surgeon using exclusively the two-clamp technique. Postoperative adverse events were retrospectively compared between these two groups. Results: There were no differences between groups in terms of postoperative stroke (1.7% single-clamp vs. 2.0% two-clamp, P=0.78), hospital mortality (2.7% single-clamp vs. 1.6% two-clamp, P=0.38), or perioperative myocardial infarction (2.6% single-clamp vs. 0.7% two-clamp, P=0.052). The two-clamp technique was not a significant predictor of stroke by logistic regression analysis (P=0.72). Conclusions: We conclude that there are no statistically significant differences between clamp techniques with regard to stroke prevention or myocardial protection. We find no compelling evidence for surgeons successfully utilizing one technique to change to the other.

Key Words: Coronary disease • Surgery • Stroke • Complications

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