Single Clamp During Off Pump Coronary Artery Bypass Grafting Reduces Postoperative Stroke

Background: Post-operative stroke rates in coronary artery bypass grafting (CABG) have been successfully reduced with the use of off pump coronary artery bypass (OPCAB). The degree and methods of aortic manipulation is an ongoing area of conjecture and we hypothesize that minimizing biphasic hypertensive episodes with a single clamp technique will correlate to an overall low stroke risk.
Objective: To determine whether the incidence of postoperative stroke could be reduced by using single aortic clamping during off pump coronary artery bypass grafting.
Methods: Between 2007-2016, 1260 consecutive patients underwent primary, isolated coronary artery bypass grafting by a single surgeon. Aortic manipulation was reduced to single clamping (n=620) and compared to multiple aortic clamping (n=640) with a logistic regression model.
Results: Postoperative stroke occurred 0.9% (n = 11), with an unadjusted incidence of 0.2% (n = 3) in the single clamp (SC) group and 0.7% (n = 8) in the multiple clamp (MC) group, (P < .01). The degree of aortic manipulation increased the ratio of observed to expected stroke rate from 0.48 in the SC group to 1.2 in the MC group. Increase in postoperative stroke is independently associated with the MC group compared with the SC group (Adjusted OR, 2.50; P < .01).
Conclusions: OPCAB is associated with overall low stroke risk with the single clamp technique further lowering the risk of stroke. It is evident that multiple clamping of the aorta during OPCAB increases the risk of postoperative stroke, regardless of the severity of aortic disease.