ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
The effect of single-clamp technique on stroke risk in coronary artery bypass surgery
Gökçen Orhan 1, Onur Sokullu 1, Yeşim Biçer2, Şahin Şenay 1, Okan Yücel 1, Batuhan Özay 1, Murat Sargın 1, Fuat Bilgen 1, Serap Aykut Aka1
1Dr. Siyami Ersek Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, İstanbul
2Dr. Siyami Ersek Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi, Anesteziyoloji Kliniği, İstanbul
Background: This study sought to determine whether the incidence of postoperative stroke would differ between patients who underwent coronary artery bypass surgery with the single-clamp technique or two-clamp technique.

Methods: A total of 534 consecutive patients who underwent isolated coronary artery bypass surgery were evaluated in two groups depending on whether the single-clamp technique (254 patients; mean age 63±8 years) or the twoclamp technique (280 patients; mean age 62±8 years) were used by two surgical teams, respectively. The two techniques were compared with respect to the incidence of postoperative stroke.

Results: Although aortic cross-clamp and cardiopulmonary bypass times were significantly longer in the single-clamp group (p<0.01), total operation times were similar. The incidence of postoperative complications, the need for inotropic support, the amount of surgical drainage, and the length of intensive care unit stay did not differ significantly. The incidences of perioperative myocardial infarction (2% vs 2.9%), stroke (1.6% vs 2.1%), and in-hospital mortality (2.4% vs 2.5%) were lower with the single-clamp use, but these did not reach significance. Stroke developed in 10 patients, occurring on the postoperative first day in four, and after the third day in the remaining patients. Correlation analyses showed that the development of stroke was significantly associated with diabetes, hypercholesterolemia, impaired ventricular function (ejection fraction <40%), atrial fibrillation, peripheral artery disease, aortic calcification, and perioperative myocardial infarction.

Conclusion: Single-clamp and side-biting clamp techniques do not differ in terms of myocardial protection and postoperative stroke rates. Therefore, there is no need for alteration in the operation technique in patients presenting a high risk for stroke.

Keywords : Cerebrovascular accident; coronary artery bypass/ methods/adverse effects
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