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Updated: Apr 3, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Effect of Aortic Clamping Strategy on Postoperative Stroke in Coronary Artery Bypass Grafting Operations
Danny Chu1, Lara Schaheen1, Victor O Morell1
1University of Pittsburgh Medical Center Heart and Vascular Institute, Pittsburgh, Pennsylvania2Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Insights
Partial aortic clamping (PAC) during coronary artery bypass grafting (CABG) does not increase stroke risk compared to single aortic clamping (SAC). This study found similar postoperative stroke rates between the two aortic clamping techniques in CABG patients.
Area of Science:
- Cardiovascular Surgery
- Neurosurgery
- Anesthesiology
Background:
- Aortic clamping technique during on-pump coronary artery bypass grafting (CABG) is a potential risk factor for stroke.
- Partial aortic clamping (PAC) is an alternative to single aortic clamping (SAC) for proximal anastomosis.
- The comparative stroke risk between PAC and SAC in CABG is not well-established.
Purpose of the Study:
- To investigate whether the use of PAC versus SAC for proximal anastomosis during CABG influences postoperative stroke incidence.
- To compare stroke rates in patients undergoing on-pump CABG with either PAC or SAC.
Main Methods:
- Retrospective cohort study of 1819 patients undergoing on-pump CABG.
- Patients were divided into two groups: those receiving proximal anastomoses with SAC (n=1107) or PAC (n=712).
- Postoperative stroke was defined by Society of Thoracic Surgeons (STS) criteria; 30-day stroke rates were analyzed.
Main Results:
- No significant differences in preoperative risk or predicted mortality were observed between SAC and PAC groups.
- Myocardial ischemic time was longer in the SAC group, while overall perfusion time was shorter.
- The 30-day observed stroke rates were similar between the SAC (1.5%) and PAC (1.4%) groups, with no statistically significant difference (P>.99).
Conclusions:
- This study did not find a significant difference in the incidence of postoperative stroke between partial aortic clamping and single aortic clamping during on-pump CABG.
- The choice of aortic clamping technique for proximal anastomosis does not appear to impact stroke risk in this patient cohort.
- These findings suggest that PAC is a safe alternative to SAC regarding stroke incidence in CABG procedures.
Importance:
Aortic clamping technique has been implicated in stroke risk at the time of on-pump coronary artery bypass grafting (CABG) procedures. We hypothesized that partial aortic clamping (PAC) use in performing proximal coronary anastomosis does not increase risk of stroke.
Objective:
To determine whether postoperative stroke incidence is influenced by single aortic clamping (SAC) or side-biting PAC use in performing proximal anastomosis during CABG procedures.
Design, Setting, And Participants:
In a retrospective cohort study, we analyzed data from 1819 patients who underwent conventional, isolated, nonemergent, first-time, arrested-heart, on-pump CABG at a single US major academic, tertiary/quaternary medical center from January 1, 2005, to December 31, 2013. Postoperative stroke was defined according to Society of Thoracic Surgeons (STS) criteria as any confirmed neurological deficit of abrupt onset that did not resolve within 24 hours. Institutional STS data including STS predicted risk of postoperative stroke score were used to compare patients receiving proximal aortic anastomoses performed with either SAC (n = 1107) or combined PAC (n = 712) techniques.
Exposures:
Use of SAC or PAC in performing proximal coronary anastomosis.
Main Outcomes And Measures:
Thirty-day periprocedural postoperative stroke rates.
Results:
There were no significant differences in preoperative risk or STS predicted risk of mortality between groups. Patients in the SAC group had longer myocardial ischemic time compared with those in the PAC group (mean [SD], 73.2 [22.8] vs 66.5 [22.8] minutes, respectively; P < .001) but shorter overall perfusion time (mean [SD], 96.6 [30.1] vs 102.2 [30.1] minutes, respectively; P < .001). The 30-day observed mortality rates between the SAC and PAC groups were equally low (21 of 1107 patients [1.9%] vs 13 of 712 patients [1.8%], respectively; P > .99) and congruent with STS predicted risk of mortality. Preoperative STS predicted risk of postoperative stroke scores were nearly identical between the SAC and PAC groups (mean [SD], 1.5% [1.4%] vs 1.6% [1.4%]; P = .95), and the 30-day actual observed postoperative stroke rates between the SAC and PAC groups were similar (17 of 1107 patients [1.5%] vs 10 of 712 patients [1.4%], respectively; P > .99).
Conclusions And Relevance:
In this contemporary study of on-pump CABG, we did not identify any significant differences in the incidence of postoperative stroke regardless of the clamping method used to perform proximal anastomosis.
