Abstract
Objectives: One of the most severe and devastating
complications following coronary artery bypass grafting (CABG) are
cerebro-vascular accidents. Atherosclerotic disease of the ascending
aorta and epi-aortic trunks has been considered the most probable cause
of cerebral embolization during CABG due to aortic manipulation and
clamping. The aim of this study is to investigate if single or double
aortic clamping may impact the incidence of neurological events.
Methods : This is a retrospective study which includes a
consecutive series of patients who underwent CABG from a single
CABG-experienced surgeon at our Institution from March 2006 to December
2012. Patients were divided into two homogenous groups based on the
surgical technique adopted: single-aortic clamping (SAC) (118 patients)
and double aortic clamp (DAC) (133 pt).
Results : Median surgical time was statistically longer for the
DAC group than for the SAC group (p= 0.015), but no significant
differences were found for the primary outcomes of stroke and transient
ischemic attack. The two groups presented a similar 30-day survival. The
follow-up was completed at 82% (median 11 years). The Kaplan-Meier
estimates a survival at 11 years of 81% and 88% for the DAC and SAC
group, respectively.
Conclusions : Incidence of stroke seems to be independent from
cross-clamping technique and, more generally, we could infer that the
global rate of stroke after CABG in low to moderate risk patients is
probably more influenced by other factors that further studies need to
address. Moreover, the appearance of the aorta at the time of surgery is
crucial to analyse to better personalize the strategy.
Keywords: coronary artery bypass artery, stroke, coronary
artery disease, neurological complications