CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 6, July 2013
AFRICA
213
Effects of single aortic clamping versus partial aortic
clamping techniques on post-operative stroke during
coronary artery bypass surgery
IHSAN SAMI UYAR, MEHMET BESIR AKPINAR, VEYSEL SAHIN, FEYZI ABACILAR, VOLKAN YURTMAN,
FAIK FEVZI OKUR, UGUR OZDEMIR, MEHMET ATES
Abstract
Background:
The aim of this study was to compare the effects
of single-clamping and partial-clamping techniques on post-
operative stroke during coronary artery bypass surgery.
Methods:
Between December 2008 and December 2012, 2 000
patients who underwent coronary artery bypass grafting
in two hospitals were analysed. Post-operative neurological
complications were analysed retrospectively in these patients.
The cases were divided into two groups: in group 1, 1 500
patients were analysed, in whom proximal anastomosis was
performed with partial clamping in a beating heart (
n
=
1 500, 846 male, 654 female; mean age 63.25
±
5.72 years;
range 43–78 years). In group 2, 500 patients were analysed,
in whom proximal anastomosis had been performed by other
surgical teams in another hospital, with cross clamping in
a resting heart with cardioplegia (
n
=
500, 296 male, 214
female; mean age 64.83
±
8.12 years; range 41–81 years).
During 30 days post-operatively, neurological deficits, stroke
incidence and the relationship of the clinical situation to
mortality were analysed.
Results:
For both groups, patients were similar in terms of
patient characteristics. In group 2, cross-clamp duration and
perfusion time were longer; however, time of hospital stay was
similar in the two groups. Post-operative stroke was seen in
26 patients in group 1 (1.73%) and in nine in group 2 (1.8%).
The difference between the two groups was not statistically
significant (
p
=
0.92). All stroke patients were over the age of
55 years. Seven of the stroke patients died (21.1%). In total,
31 patients died because of multiple organ failure in the post-
operative 30 days (group 1: 1.6%; group 2: 1.4%) (
p
=
0.91).
Smoking, diabetes mellitus, hypertension, atrial fibrillation,
peripheral vascular disease and hypercholesterolaemia were
found to be factors that affected stroke development. Mean
duration of hospital stay was 5.1
±
2.8 days in group 1 and
4.9
±
3.6 days in group 2 and the difference between the two
groups was not statistically significant (
p
=
0.46).
Conclusion:
In patients without plaques in the aorta, perform-
ing partial clamping did not increase stroke incidence.
Keywords:
coronary bypass, stroke, partial clamp
Submitted 10/4/13, accepted 10/5/13
Cardiovasc J Afr
2013;
24
: 213–217
DOI: 10.5830/CVJA-2013-038
Neurological complications are undoubtedly among the most
important adverse outcomes of coronary artery bypass surgery.
Neurological problems increase morbidity and mortality
considerably. Although techniques performed during cardiac
surgery have progressed, neurological complications have not
disappeared completely. The real causes of these complications
may be problems associated with atherosclerosis that is present
before the operation or with surgical technical failure. Advanced
age, carotid artery disease and severe calcification of the aorta
are the main factors that increase the risk of neurological
complications.
1-3
There are many studies in the literature on the prevention of
these problems, and they suggest technical solutions. However,
concerns about the safety of these techniques and the neurological
complications still exist.
Patients with similar demographic characteristics who were
treated with coronary artery bypass grafting (CABG) at our
clinic were evaluated retrospectively in this study. The results
obtained by a team using a single aortic clamp for the proximal
anastomosis were compared with those obtained by a team
utilising partial clamping for the proximal anastomosis. The
study sought to observe whether either of these techniques
increased the incidence of post-operative stroke.
Methods
In this study, 2 000 patients who had undergone CABG in two
hospitals between December 2008 and December 2012 were
evaluated retrospectively for neurological complications and
mortality in the post-operative period. The cases were divided
into two groups. Data from the 1 500 patients in whom proximal
anastomosis had been performed with partial clamping were
evaluated as group 1 (
n
=
1 500; 846 males, 654 females; age
63.25
±
5.72 years; range of 43–78 years). The data from the
patients (treated by another surgical team in another hospital) in
whom proximal anastomosis had been performed in the stopped
heart with cross clamping were evaluated as group 2 (
n
=
500;
296 males, 214 females; mean age 64.83
±
8.12 years; range
41–81 years). The data for these two groups were compared.
The study was planned, and approval of the hospital ethics
committee was obtained. The informed consent forms of all
patients were seen in chart review, and cases that did not have
an informed consent form were excluded. Patients with plaques
in the aorta and with a history of corticosteroid, salicylate,
Department of Cardiovascular Surgery, Medical Faculty, Sifa
University Izmir, Turkey
IHSAN SAMI UYAR, MD,
MEHMET BESIR AKPINAR, MD
VEYSEL SAHIN, MD
FEYZI ABACILAR, MD
VOLKAN YURTMAN, MD
FAIK FEVZI OKUR, MD
UGUR OZDEMIR
MEHMET ATES, MD
