title: Single-clamp technique does not protect against cerebrovascular accident in coronary artery bypass grafting.
abstract: OBJECTIVE
  By potentially avoiding the embolic consequences of a side-biting aortic clamp, the single-clamp technique may decrease cerebrovascular accidents in coronary artery bypass grafting. However, this theoretical superiority in stroke prevention has not been conclusively demonstrated and use of this technique may lead to adverse myocardial effects due to longer cross-clamp times. In this study, we sought to determine if the single-clamp technique prevents postoperative stroke in clinical practice.
  
  
  METHODS
  Of 607 consecutive isolated coronary bypass operations completed over a 3 year period, 301 (50%) were performed by one surgeon using exclusively the single-clamp technique and 306 (50%) were performed by a second surgeon using exclusively the two-clamp technique. Postoperative adverse events were retrospectively compared between these two groups.
  
  
  RESULTS
  There were no differences 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% two-clamp, P=0.38), or perioperative myocardial infarction (2.6% single-clamp vs. 0.7% two-clamp, P=0.052). The two-clamp technique was not a significant predictor of stroke by logistic regression analysis (P=0.72).
  
  
  CONCLUSIONS
  We conclude that there are no statistically significant differences between clamp techniques with regard to stroke prevention or myocardial protection. We find no compelling evidence for surgeons successfully utilizing one technique to change to the other.
authors: Department of Surgery, Section of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, CT 06510, USA.
authors: R W
authors: RW
authors: Kim
authors: D C
authors: DC
authors: Mariconda
authors: G
authors: G
authors: Tellides
authors: G S
authors: GS
authors: Kopf
authors: M L
authors: ML
authors: Dewar
authors: Z
authors: Z
authors: Lin
authors: J A
authors: JA
authors: Elefteriades
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D003250:Constriction; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D020521:Stroke / Q000517:prevention & control*; D016896:Treatment Outcome