Introduction
Neurological complications - specifically stroke - following coronary artery bypass grafting (CABG) operations have been reported with an incidence between 0.8%-5.2% [1,2]. Despite the relatively low incidence, the consequences are often devastating [3,4].
Since the occurrence of neurological events dramatically impacts the prognosis and quality of life of the patients, any effort must be pursuit to avoid iatrogenic stroke following CABG. Atherosclerotic disease of the ascending aorta has been considered one of the most probable cause of cerebral embolization due to dislodgement of plaque debris during aortic manipulation and cross-clamping [5-7].
Among the strategies to decrease or eliminate aortic manipulation, off-pump CABG through an aortic “no touch” technique has been advocated as one of the most useful strategy in reducing the stroke rate [8,9], even though it might lead to worse graft patency and survival [10], especially in low-volume Centers [11,12].
However, this off-pump aortic “no touch” technique is not universally applicable and, when saphenous vein and/or free arterial aorto-coronary grafts are used, there is still risk of neurological injury due to tangential aortic clamp applied during the proximal anastomoses sewing.
To minimize aortic manipulation and trauma in standard on-pump CABG, a single aortic clamp (SAC) rather than a double aortic clamp (DAC) has also been proposed, to reduce the manipulation and stretching of the aorta [13-15].
The conclusions of these reports have been conflicting, although in several papers SAC technique showed superiority in reducing neurologic injury following CABG causing less neuropsychological deficits and release of serum S-100 protein, a surrogate marker of cerebral injury [16-18].
On the other hand, SAC prolongs cardiopulmonary bypass (CPB) time, which is also per se considered an independent risk factor for cerebrovascular accidents. Indeed, other papers have reported no benefit of SAC over DAC technique in preventing the neurological lesions [19-21], suggesting that other factors might be accountable for stroke, such as cannulation [22](cannulation strategy, type of cannula) and even the aortic punch [23].
Given this background, we retrospectively compared the early and long-term neurological outcomes between two homogeneous CABG groups treated with either SAC or DAC technique.