The effects of single clamp and double clamp techniques on cardiac and neurological outcome was retrospectively evaluated in 1500 patients.

Methods:

In 680 cases (Group 1) distal and proximal anastomoses were completed during single cross clamp period. In 820 cases (Group 2) the cross clamp was removed after the distal anastomoses were completed and a side clamp was applied for the proximal anastomoses. Emergency cases and combined cases were excluded.

Results:

There was no difference in age , gender, number of bypasses and left ventricular function between two groups (p = 0.18). There were more patients with more comorbidities in group 1 (p = 0.05). Myocardial protection was achieved with antegrade-retrograde tepid cardioplegia. Mean number of distal anastomoses was 2.9 ± 0.7 in Group 1 and 3 ± 0.7 in Group 2. There was no difference in duration of ischemia between two groups but cardiopulmonary bypass time and duration of weaning from cardiopulmonary bypass was shorter in group 1 (p < 0.05). Both groups needed the same amount of inotropics postoperatively. CPK values were higher in Group 1 but there was no difference between CPK-MB values and peroperative MI rates between two groups. Mortality was 5 patients (0.9 %) in Group 1 and 8 patients (1 %) in Group 2. Five patients in Group 1 and 18 patients in Group 2 developed a major neurological deficit (p = 0.018). Four patients in Group 2 died because of neurological complications.

Conclusions:

The single clamp technique has the advantage of less aortic manipulation and allowing full revascularisation after cross clamp removal. We failed to show any advantage of the single clamp technique for myocardial protection, however there were significantly less neurological complications in the single clamp technique group.