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Side-Clamping Versus Single Cross-Clamping in On-Pump CABG: Impact on Early Hematologic Outcomes and Blood
Hakan Öntaş1, Asiye Aslı Gözüaçık Rüzgar2
1Department of Cardiovascular Surgery, Balikesir University, Balıkesir 10145, Türkiye.
Insights
The side-clamp technique in coronary artery bypass grafting (CABG) surgery led to a smaller drop in hemoglobin and less chest tube drainage compared to single cross-clamping. This approach may improve patient blood management (PBM) outcomes.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Hematology
Background:
- Aortic manipulation and prolonged ischemia during cardiopulmonary bypass (CPB) are linked to perioperative complications.
- Optimizing aortic clamping strategies is essential for minimizing blood loss and enhancing recovery within Patient Blood Management (PBM) frameworks.
Purpose of the Study:
- To compare the impact of single cross-clamping versus side-clamping on early hematologic outcomes in on-pump coronary artery bypass grafting (CABG) patients.
- To evaluate the effectiveness of different aortic clamping strategies within a Patient Blood Management (PBM) context.
Main Methods:
- A retrospective cohort study analyzed 265 patients undergoing on-pump CABG.
- Patients were divided into two groups: Side-Clamp (n=132) and Single Cross-Clamp (n=133).
- Primary outcomes included postoperative hemoglobin (Hb) drop and 24-hour chest tube drainage.
Main Results:
- The side-clamp technique resulted in significantly shorter cardioplegic arrest times (34.5 vs. 52.0 min).
- Postoperative Hb drop was significantly lower in the side-clamp group (1.9 vs. 2.1 g/dL).
- The side-clamp group also showed significantly lower 24-hour chest tube drainage (123.4 vs. 131.0 mL).
Conclusions:
- The side-clamp strategy offers modest but significant reductions in postoperative hemoglobin decline and chest tube drainage.
- While not reducing RBC transfusion or early mortality, it's a valuable component of PBM in CABG.
- This technique may contribute to improved patient blood management during on-pump CABG.
Abstract:
Aortic manipulation and prolonged ischemia during cardiopulmonary bypass remain major drivers of perioperative complications. Optimizing clamping strategies is crucial to minimize iatrogenic blood loss and improve recovery profiles within a Patient Blood Management (PBM) framework. Objectives: This study aimed to evaluate the impact of two different aortic clamping strategies-single cross-clamping versus side-clamping-on early hematologic outcomes within a Patient Blood Management (PBM) framework in patients undergoing on-pump coronary artery bypass grafting (CABG). Methods: In this retrospective cohort study, 265 patients who underwent elective isolated 3-vessel on-pump CABG between January 2019 and April 2025 were analyzed. Patients were divided into two groups: the Side-Clamp group (n = 132), where proximal anastomoses were performed under partial occlusion after releasing the main cross-clamp, and the Single Cross-Clamp group (n = 133), where all anastomoses were completed during a single arrest period. The primary outcomes were postoperative hemoglobin (Hb) drop and 24-h chest tube drainage. Results: The side-clamp technique was associated with significantly shorter cardioplegic arrest times (34.5 ± 3.7 vs. 52.0 ± 3.9 min; p < 0.001). Key findings revealed that the postoperative hemoglobin drop was significantly lower in the side-clamp group (1.9 ± 0.4 g/dL vs. 2.1 ± 0.4 g/dL; p = 0.005). Notably, the side-clamp group also exhibited significantly lower 24-h chest tube drainage (123.4 ± 28.3 mL vs. 131.0 ± 27.4 mL; p = 0.027). Multivariate linear regression analysis, adjusting for age, sex, and CPB time, confirmed the side-clamp technique as an independent predictor of superior hemoglobin preservation (β = -0.115, p = 0.009). No significant differences were observed regarding the incidence of postoperative AF (13.6% vs. 15.8%; p = 0.748) or 30-day mortality. Conclusions: The side-clamp strategy is associated with modest but statistically significant reductions in postoperative hemoglobin decline and 24-h chest tube drainage. While these differences did not translate into a significant reduction in RBC transfusion or early mortality, the side-clamp technique represents a useful technical component within a broader Patient Blood Management strategy in routine on-pump CABG practice.
