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.