Aortic Clamping Strategy During Coronary Artery Bypass Grafting: Partial or Single? A Propensity-Matched Analysis

This study aimed to investigate the relationship between partial aortic clamping (PAC) and single aortic clamping (SAC) techniques during isolated coronary artery bypass grafting (CABG) and their impact on clinical outcomes.

Between 2022 and 2026, 974 patients who underwent isolated CABG were retrospectively evaluated. The study cohort was initially divided based on the operative technique into Group A (PAC, n = 626) and Group B (SAC, n = 348). To account for baseline clinical disparities, a 1:1 propensity score-matched (PSM) analysis was performed, yielding two balanced subgroups: Group C (PAC, n = 218) and Group D (SAC, n = 218).

Following propensity matching, the median cross-clamp (XCL) time was significantly lower in the PAC group compared to the SAC group (73 min vs. 100 min, p < 0.001). No statistically significant differences were observed between the balanced groups regarding postoperative exploration, cerebrovascular accidents, continuous renal replacement therapy requirements, or all-cause in-hospital mortality. The incidence of NOAF was significantly lower in the PAC group than in the SAC group [24 (11.0%) vs. 49 (22.5%), p = 0.001; absolute risk difference 11.5%, 95% CI 4.5-18.4%; number needed to treat ≈9]. Multivariate logistic regression analysis identified the SAC technique as an independent predictor of NOAF (p = 0.001, OR= 2.531 [95% CI, 1.442-4.441]).

This study demonstrated no significant differences between the PAC and SAC techniques regarding postoperative bleeding, blood product utilization, and major neurological or renal complications. However, the PAC strategy was associated with a significantly lower incidence of NOAF compared to the SAC technique.