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Ann Thorac Surg 2002;73:S376
© 2002 The Society of Thoracic Surgeons

SUPPLEMENT: OUTCOMES 2001: SCIENTIFIC ABSTRACTS

Impact of single-clamp versus double-clamp technique on neurologic outcome after coronary artery bypass grafting

M.A. Grega, MSNa, L.M. Borowicz, MSa, W.A. Baumgartner, MDa

a The Johns Hopkins Hospital, Baltimore, Maryland, USA

Background. Atherosclerosis of the aorta with clamping and manipulation during surgery has been identified as a risk factor for neurologic complications after coronary artery bypass grafting (CABG). We reviewed a change in clamping technique (for a single surgeon) to determine its impact on neurologic outcomes.

Methods. Patients undergoing isolated CABG were identified as having double-clamp (DC) technique (aortic cross-clamp + sidebiting clamp) or single-clamp (SC) technique (aortic cross-clamp only). Prospective neurologic assessment was completed and data were reviewed using our institutional stroke database.

Results. Two hundred seventy-two patients had DC technique and 189 patients had SC technique. There were no differences in age, or in a history of stroke, hypertension, or diabetes. Patients with SC technique had shorter cardiopulmonary bypass times (115 vs 128 minutes, p = 0.001), longer aortic cross-clamp times (89 vs 80 minutes, p = 0.001), fewer coronary grafts placed (2.8 vs 3.1, p = 0.001), and had, on average, higher mean arterial blood pressure on CPB (76 vs 69 mm Hg, p = 0.001). Postoperatively, the SC group had fewer strokes (1.1% vs 2.9%, NS), and neurologic injury/encephalopathy (3.2% vs 9.6%, p = 0.008). By multivariate analysis, the factors significantly related to the outcome of neurologic injury were double-clamp technique (p = 0.04), patient age (p = 0.001), and number of coronary grafts placed (p = 0.03).

Conclusions. In this single surgeon’s experience, the use of the single-clamp technique appears important in reducing the incidence of neurologic injury after CABG.





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