title: Single crossclamp: Safe training tool for coronary artery bypass grafting.
abstract: OBJECTIVE
  The single-crossclamp technique for coronary artery bypass grafting is recognized to reduce manipulation of the ascending aorta, and thereby improve neurological outcomes. However, there is a perceived disadvantage of long cardiopulmonary bypass and crossclamp times. Our objective was to evaluate outcomes with this technique and determine whether it is safe for training.
  
  
  METHODS
  Patients undergoing coronary artery bypass between October 2005 and February 2014 with use of the single-crossclamp method were divided into 2 groups: a consultant group (n = 1024), and a trainee group (n = 504), depending on the primary surgeon. Their outcomes were compared.
  
  
  RESULTS
  The consultants operated on more nonelective patients who had a higher risk profile (mean additive EuroSCORE I 4.05 vs. 3.80, p = 0.085; logistic EuroSCORE I 4.36 vs. 3.64, p = 0.002). There were 9 (0.9%) deaths in the consultant group and 5 (1%) in the trainee group. The mean number of grafts in the consultant group was greater, but the crossclamp time was similar and cardiopulmonary bypass time was shorter. There were 4 (0.4%) cerebrovascular events in the consultant group and 3 (0.6%) in the trainee group. Postoperative stay was shorter in the trainee group (7.19 vs. 7.97 days, p = 0.033). Other complication rates were similar.
  
  
  CONCLUSIONS
  The technique has excellent outcomes, especially neurological, and is safe for training junior surgeons.
authors.affiliation: Department of Cardiothoracic Surgery, Victoria Hospital, Blackpool, UK srivivek50@hotmail.com.
authors.forename: Vivek
authors.initials: V
authors.lastname: Srivastava
authors.affiliation: Department of Cardiothoracic Surgery, Victoria Hospital, Blackpool, UK.
authors.forename: Manoj
authors.initials: M
authors.lastname: Purohit
authors.affiliation: Department of Cardiothoracic Surgery, Victoria Hospital, Blackpool, UK.
authors.forename: Amal
authors.initials: A
authors.lastname: Bose
authors.affiliation: Department of Cardiothoracic Surgery, Victoria Hospital, Blackpool, UK.
authors.forename: Mohamed Nidal
authors.initials: MN
authors.lastname: Bittar
authors.affiliation: Department of Cardiothoracic Surgery, Victoria Hospital, Blackpool, UK.
authors.forename: Shaun
authors.initials: S
authors.lastname: Rogers
authors.affiliation: Department of Cardiothoracic Surgery, Victoria Hospital, Blackpool, UK.
authors.forename: Joseph
authors.initials: J
authors.lastname: Zacharias
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D002983:Clinical Competence; D003253:Consultants; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000193:education* / Q000295:instrumentation / Q000401:mortality; D016208:Databases, Factual; D004503:Education, Medical, Graduate / Q000379:methods*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D061214:Patient Safety; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D066231:Surgeons / Q000193:education*; D013525:Surgical Instruments; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cardiopulmonary bypass; Clinical competence; Coronary artery bypass; Coronary disease; Education; Treatment outcome; graduate; medical