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Impact of single clamp versus double clamp technique on neurologic outcome
Maura A Grega1, Louis M Borowicz, William A Baumgartner
1Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland 21287-4618, USA.
Insights
The single clamp technique (SCT) in coronary artery bypass grafting (CABG) is associated with fewer neurologic injuries compared to the double clamp technique (DCT). This change in surgical approach may improve patient outcomes after CABG surgery.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Medical Device Technology
Background:
- Aortic manipulation during coronary artery bypass grafting (CABG) poses a risk for neurologic complications.
- Atherosclerotic disease of the aorta is a known risk factor for these complications.
Purpose of the Study:
- To evaluate the impact of transitioning from a double clamp technique (DCT) to a single clamp technique (SCT) on neurologic outcomes in patients undergoing CABG.
- To determine if the SCT reduces the incidence of stroke and other neurologic injuries post-CABG.
Main Methods:
- A retrospective review of 461 patients undergoing isolated CABG by a single surgeon was conducted.
- Patients were categorized based on the aortic clamping technique used: DCT (aortic cross clamp + side-biting clamp) or SCT (aortic cross clamp only).
- Neurologic outcomes, including stroke and various forms of neurologic injury, were collected and analyzed.
Main Results:
- The SCT group (189 patients) experienced fewer postoperative strokes (1.1% vs. 2.9%) and neurologic injuries (3.2% vs. 9.6%) compared to the DCT group (272 patients).
- Multivariate analysis identified DCT, patient age, and the number of coronary grafts as significant factors related to neurologic injury.
- Intraoperative findings showed SCT was associated with shorter bypass times but longer aortic cross-clamp times.
Conclusions:
- The adoption of the single clamp technique (SCT) may be a key factor in mitigating neurologic injury following coronary artery bypass grafting.
- This surgical modification shows promise for improving patient safety and neurologic outcomes in CABG procedures.
Background:
Atherosclerotic disease of the aorta has been identified as a risk factor for neurologic complications following coronary artery bypass grafting (CABG) due to the use of aortic clamping and manipulation. We reviewed a change from double clamp to single clamp technique to determine its impact on neurologic outcomes.
Methods:
Patients undergoing isolated CABG by a single surgeon were identified as having double clamp technique (DCT) (aortic cross clamp + sidebiting clamp) or single clamp technique (SCT) (aortic cross clamp only). Data were collected by study personnel and clinicians to determine stroke and neurologic injury (confusion, delirium, seizure, altered mental status, and agitation) outcomes for 461 patients.
Results:
Two hundred seventy-two patients had DCT and 189 patients had SCT performed. There were no differences in mean age, previous stroke, hypertension, or diabetes. Intraoperatively, patients with SCT had shorter bypass times (115 minutes vs 128 minutes, p = 0.001), longer aortic cross clamp time (89 minutes vs 80 minutes, p = 0.001), fewer coronary grafts (2.8 vs 3.1, p = 0.001), and had higher mean arterial blood pressure on cardiopulmonary bypass (76 mm Hg vs 69 mm Hg, p = 0.001). Postoperatively, the SCT group had fewer strokes (1.1% vs 2.9%, NS), and neurologic injuries (3.2% vs 9.6%, p = 0.008). By multivariate analysis, the factors that were related to neurologic injury were DCT (p = 0.04), age (p = 0.001), and number of coronary grafts (p = 0.03).
Conclusions:
This experience suggests that the use of the SCT may be important in reducing neurologic injury following CABG.
