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Cross-Clamp Technique and Incidence of Stroke after Coronary Artery Bypass Grafting: Know and Respect the Aorta Principle
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  • Giorgio Mastroiacovo,
  • Marco Gennari,
  • Ilaria Giambuzzi,
  • Sergio Pirola,
  • Giuseppe Nanci,
  • Alice Bonomi,
  • Gabriele Egidy Assenza,
  • Gianluca Polvani,
  • Marco Agrifoglio
Giorgio Mastroiacovo
Centro Cardiologico Monzino IRCCS
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Marco Gennari
Centro Cardiologico Monzino IRCCS
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Ilaria Giambuzzi
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Sergio Pirola
Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico
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Giuseppe Nanci
Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico
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Alice Bonomi
Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico
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Gabriele Egidy Assenza
IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi Dipartimento cardio-toracico-vascolare
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Gianluca Polvani
centro cardiologico monzino
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Marco Agrifoglio
Centro Cardiologico Monzino
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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 series of patients who underwent CABG from a single surgeon at our Institution from March 2006 to December 2012. Patients were divided into two homogenous groups based on the surgical technique: single-aortic clamping (SAC) (118 patients) and double aortic clamp (DAC) (133 pt). Results: Median surgical time was 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 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.