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Published on: September 25, 2009
Single-clamp technique does not protect against cerebrovascular accident in coronary artery bypass grafting
R W Kim1, D C Mariconda, G Tellides
1Department of Surgery, Section of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, CT 06510, USA.
Insights
The single-clamp technique in coronary artery bypass grafting does not significantly reduce stroke or protect the myocardium compared to the two-clamp technique. This study found no compelling evidence to favor one clamp method over the other for patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Neurosurgery
- Anesthesiology
Background:
- The single-clamp technique for aortic access during coronary artery bypass grafting (CABG) theoretically reduces stroke risk by avoiding aortic clamp emboli.
- However, concerns exist regarding potential adverse myocardial effects due to potentially longer cross-clamp times with the single-clamp method.
- Clinical evidence comparing the single-clamp and two-clamp techniques for stroke prevention and myocardial protection is limited.
Purpose of the Study:
- To compare the incidence of postoperative stroke and myocardial infarction between the single-clamp and two-clamp techniques in isolated CABG.
- To evaluate the clinical effectiveness of the single-clamp technique in preventing cerebrovascular accidents.
Main Methods:
- A retrospective analysis of 607 consecutive isolated CABG operations over three years.
- Patients were divided into two groups: 301 undergoing the single-clamp technique and 306 undergoing the two-clamp technique.
- Postoperative adverse events, including stroke, mortality, and myocardial infarction, were compared between the groups.
Main Results:
- No statistically significant difference in postoperative stroke rates was observed (1.7% single-clamp vs. 2.0% two-clamp; P=0.78).
- Hospital mortality rates were similar between groups (2.7% single-clamp vs. 1.6% two-clamp; P=0.38).
- A trend towards higher perioperative myocardial infarction in the single-clamp group did not reach statistical significance (2.6% vs. 0.7%; P=0.052).
Conclusions:
- The single-clamp technique does not offer statistically significant advantages over the two-clamp technique in preventing stroke or protecting the myocardium during CABG.
- There is no compelling clinical evidence to support a change in surgical practice from the two-clamp to the single-clamp technique based on these findings.
- Both techniques appear to yield comparable outcomes regarding major perioperative complications.
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.
