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n Cardiovascular Journal of Africa - Effects of single aortic clamping versus partial aortic clamping techniques on post-operative stroke during coronary artery bypass surgery : cardiovascular topic

Volume 24, Issue 6
  • ISSN : 1995-1892
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Abstract

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.


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 ( = 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 ( = 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.
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 ( = 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%) ( = 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 ( = 0.46).
In patients without plaques in the aorta, performing partial clamping did not increase stroke incidence.

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/content/cardio1/24/6/EJC140530
2013-07-01
2016-12-09

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