title: Single aortic clamp versus partial occluding clamp technique for cerebral protection during coronary artery bypass: a randomized prospective trial.
abstract: Single aortic clamp (SAC) versus partial occluding clamp (POC) technique for the construction of proximal anastomosis has been suggested to provide better cerebral protection during coronary artery bypass grafting (CABG). The aim of this study was to assess this hypothesis in a prospective randomized trial.
  
  
  METHODS
  Two hundred sixty-eight consecutive patients underwent CABG at a single institution. All patients were randomized to either SAC (Group S) or POC (Group P) for the construction of the proximal anastomosis. Myocardial protection consisted of multidose antegrade cold blood cardioplegia with topical cooling. The operations were performed using standard cardiopulmonary bypass support and moderate systemic hypothermia (29 to 32 degrees C). The incidences of neurological events, perioperative myocardial infarction (MI), and mortality were prospectively evaluated.
  
  
  RESULTS
  The two groups were similar in mean age, gender, urgency of operation, and number of bypasses. Group S patients had a significantly longer cross-clamp (61 +/- 21 minutes [S] vs 44 +/- 13.8 minutes [P], p < 0.05) and bypass times (85 +/- 25 minutes [S] vs 74 +/- 19.7 minutes [P], p < 0.05). There were no differences in the number of perioperative MIs (Group S = 3 [2.3%]; Group P = 2 [1.5%], p = 0.50) or mortality (Group S = 2 [1.5%]; Group P = 3 [2.2%], p = 0.50). Two patients randomized to POC were switched to SAC intraoperatively because of severe calcification of the ascending aorta. In Group P, there were two strokes (1.5%) and two (1.5%) postoperative confusions versus none in Group S (relative risk = 2.0, p < 0.05, respectively).
  
  
  CONCLUSIONS
  The SAC technique improved cerebral protection without any adverse effect on myocardial protection and postoperative outcome in patients undergoing CABG.
authors.affiliation: Division of Cardiac Surgery, The Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: John C
authors.initials: JC
authors.lastname: Tsang
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Morin
authors.forename: Christo I
authors.initials: CI
authors.lastname: Tchervenkov
authors.forename: Robert W
authors.initials: RW
authors.lastname: Platt
authors.forename: John
authors.initials: J
authors.lastname: Sampalis
authors.forename: Dominique
authors.initials: D
authors.lastname: Shum-Tim
mesh_terms: D000368:Aged; D001921:Brain / Q000098:blood supply*; D002545:Brain Ischemia / Q000517:prevention & control*; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D003250:Constriction; D001026:Coronary Artery Bypass / Q000295:instrumentation / Q000379:methods*; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome