Single-clamp technique does not protect against cerebrovascular accident in coronary artery bypass grafting

Objectives: By potentially avoiding the embolic consequences of a side-biti ng aortic clamp, the single-clamp technique may decrease cerebrovascular ac cidents in coronary artery bypass grafting. However, this theoretical super iority in stroke prevention has not been conclusively demonstrated and use of this technique may lead to adverse myocardial effects due to longer cros s-clamp times. In this study, we sought to determine if the single-clamp te chnique prevents postoperative stroke in clinical practice. Methods: Of 607 consecutive isolated coronary bypass operations completed over a 3 year pe riod, 301 (50%) were performed by one surgeon using exclusively the single- clamp technique and 306 (50%) were performed by a second surgeon using excl usively the two-clamp technique. Postoperative adverse events were retrospe ctively compared between these two groups. Results: There were no differenc es 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% tw o-clamp, P = 0.38), or perioperative myocardial infarction (2.6% single-cla mp vs. 0.7% two-clamp, P = 0.052). The two-clamp technique was not a signif icant predictor of stroke by logistic regression analysis (P = 0.72). Concl usions: We conclude that there are no statistically significant differences between clamp techniques with regard to stroke prevention or myocardial pr otection. We find no compelling evidence for surgeons successfully utilizin g one technique to change to the other. (C) 2001 Elsevier Science B.V. All rights reserved.