Document Detail

Impact of single clamp versus double clamp technique on neurologic outcome.
MedLine Citation:
PMID:  12735551     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Atherosclerotic disease of the aorta has been identified as a risk factor for neurologic complications following coronary artery bypass grafting (CABG) due to the use of aortic clamping and manipulation. We reviewed a change from double clamp to single clamp technique to determine its impact on neurologic outcomes. METHODS: Patients undergoing isolated CABG by a single surgeon were identified as having double clamp technique (DCT) (aortic cross clamp + sidebiting clamp) or single clamp technique (SCT) (aortic cross clamp only). Data were collected by study personnel and clinicians to determine stroke and neurologic injury (confusion, delirium, seizure, altered mental status, and agitation) outcomes for 461 patients. RESULTS: Two hundred seventy-two patients had DCT and 189 patients had SCT performed. There were no differences in mean age, previous stroke, hypertension, or diabetes. Intraoperatively, patients with SCT had shorter bypass times (115 minutes vs 128 minutes, p = 0.001), longer aortic cross clamp time (89 minutes vs 80 minutes, p = 0.001), fewer coronary grafts (2.8 vs 3.1, p = 0.001), and had higher mean arterial blood pressure on cardiopulmonary bypass (76 mm Hg vs 69 mm Hg, p = 0.001). Postoperatively, the SCT group had fewer strokes (1.1% vs 2.9%, NS), and neurologic injuries (3.2% vs 9.6%, p = 0.008). By multivariate analysis, the factors that were related to neurologic injury were DCT (p = 0.04), age (p = 0.001), and number of coronary grafts (p = 0.03). CONCLUSIONS: This experience suggests that the use of the SCT may be important in reducing neurologic injury following CABG.
Maura A Grega; Louis M Borowicz; William A Baumgartner
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  75     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2003 May 
Date Detail:
Created Date:  2003-05-08     Completed Date:  2003-05-22     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1387-91     Citation Subset:  AIM; IM    
Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland 21287-4618, USA.
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MeSH Terms
Coronary Artery Bypass / adverse effects*,  methods*
Delirium, Dementia, Amnestic, Cognitive Disorders / etiology*
Middle Aged
Multivariate Analysis
Prospective Studies
Risk Factors
Stroke / etiology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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