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For patients undergoing coronary artery bypass grafting at higher risk of stroke is the single cross-clamp technique of benefit in reducing the incidence of stroke?

Department of Cardiothoracic Surgery, Harefield Hospital, Hill End Road, Harefield, UB9 6JH, Middlesex, UK

*Corresponding author. Tel.: +44 1895 828665; fax: +44 1895 828666.

E-mail address: drrajashahzad{at}hotmail.com (S.G. Raja).

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether, for patients undergoing coronary artery bypass grafting at higher risk of stroke, the single cross-clamp (SC) technique is of benefit in reducing the incidence of stroke. Using the reported search 458 papers were identified. Six randomised controlled trials (RCTs), of which one was a duplicate publication, represented the best evidence on the subject. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study comments and weaknesses were tabulated for these. We conclude that current best available evidence, from six RCTs randomising 490 patients, suggests that there is no benefit of SC technique over multiple cross-clamp (MC) technique in terms of reduction in the incidence of stroke (SC=2/206 vs. MC=7/284; P=ns) although there is some advantage of SC technique in causing less neuropsychological deficits and release of serum S-100 protein, a surrogate marker of cerebral injury.

Key Words: Coronary artery bypass grafting; Stroke; Focal neurologic deficit; Evidence-based medicine