title: Trends in aortic clamp use during coronary artery bypass surgery: effect of aortic clamping strategies on neurologic outcomes.
abstract: OBJECTIVE
  The purpose of the present study was to determine the effect of different clamping strategies during coronary artery bypass grafting on the incidence of postoperative stroke.
  
  
  METHODS
  In the present case-control study, all patients at Emory hospitals from 2002 to 2009 with postoperative stroke after isolated coronary artery bypass grafting (n = 141) were matched 1:4 to a contemporaneous cohort of patients without postoperative stroke (n = 565). The patients were matched according to the Society of Thoracic Surgeons' predicted risk of postoperative stroke score, which is based on 26 variables. The patients who received on-pump and off-pump coronary artery bypass grafting were matched separately. Multiple logistic regression analysis with adjusted odds ratios was performed to identify the operative variables associated with postoperative stroke.
  
  
  RESULTS
  Among the on-pump cohort, the single crossclamp technique was associated with a decreased risk of stroke compared with the double clamp (crossclamp plus partial clamp) technique (odds ratio, 0.385; P = .044). Within the on-pump cohort, no significant difference was seen in the incidence of stroke according to clamp use. Epiaortic ultrasound of the ascending aorta increased from 45.3% in 2002 to 89.4% in 2009. From 2002 to 2009, clamp use decreased from 97.7% of cases to 72.7%.
  
  
  CONCLUSIONS
  During on-pump coronary artery bypass grafting, the use of a single crossclamp compared with the double clamp technique decreased the risk of postoperative stroke. The use of any aortic clamp decreased and epiaortic ultrasound use increased from 2002 to 2009, indicating a change in the operative technique and surgeon awareness of the potential complications associated with manipulation of the aorta.
authors.affiliation: Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga.
authors.forename: William T
authors.initials: WT
authors.lastname: Daniel
authors.affiliation: Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga.
authors.forename: Patrick
authors.initials: P
authors.lastname: Kilgo
authors.affiliation: Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga.
authors.forename: John D
authors.initials: JD
authors.lastname: Puskas
authors.affiliation: Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga.
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Thourani
authors.affiliation: Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga.
authors.forename: Omar M
authors.initials: OM
authors.lastname: Lattouf
authors.affiliation: Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Guyton
authors.affiliation: Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga. Electronic address: mhalkos@emory.edu.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Halkos
mesh_terms: D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging / Q000601:surgery*; D016022:Case-Control Studies; D003250:Constriction; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods / Q000639:trends*; D047549:Coronary Artery Bypass, Off-Pump / Q000639:trends; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000517:prevention & control; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: 23.1.1; 23.1.3; 23.1.4; 38.2; CABG; ONCAB; OPCAB; PROPS; STS; Society of Thoracic Surgeons; coronary artery bypass grafting; off-pump coronary artery bypass; on-pump coronary artery bypass; predicted risk of postoperative stroke