Single crossclamp: Safe training tool for coronary artery bypass grafting. (September 2016)

• Record Type: Journal Article
• Authors: Srivastava, Vivek; Purohit, Manoj; Bose, Amal; Bittar, Mohamed Nidal; Rogers, Shaun; Zacharias, Joseph
• Is Part Of: Asian cardiovascular & thoracic annals. Volume 24:Number 7(2016)
• Page Start: 633
• Page End: 637
• Publication Date: 2016-09
• Subjects: Cardiopulmonary bypass -- Clinical competence -- Coronary artery bypass -- Coronary disease -- Education -- medical -- graduate -- Treatment outcome; Heart -- Diseases -- Asia -- Periodicals; Heart -- Diseases -- Pacific Area -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Surgery -- Asia -- Periodicals; Heart -- Surgery -- Pacific Area -- Periodicals; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Asia -- Periodicals; Chest -- Surgery -- Pacific Area -- Periodicals; Chest -- Surgery -- Periodicals; 617.412
• DOI: 10.1177/0218492316657242
• Languages: English
• ISSNs: 0218-4923

Abstract

Objective: The single-crossclamp technique for coronary artery bypass grafting is recognized to reduce manipulation of the ascending aorta, and thereby improve neurological outcomes. However, there is a perceived disadvantage of long cardiopulmonary bypass and crossclamp times. Our objective was to evaluate outcomes with this technique and determine whether it is safe for training. Methods: Patients undergoing coronary artery bypass between October 2005 and February 2014 with use of the single-crossclamp method were divided into 2 groups: a consultant group ( n = 1024), and a trainee group ( n = 504), depending on the primary surgeon. Their outcomes were compared. Results: The consultants operated on more nonelective patients who had a higher risk profile (mean additive EuroSCORE I 4.05 vs. 3.80, p = 0.085; logistic EuroSCORE I 4.36 vs. 3.64, p = 0.002). There were 9 (0.9%) deaths in the consultant group and 5 (1%) in the trainee group. The mean number of grafts in the consultant group was greater, but the crossclamp time was similar and cardiopulmonary bypass time was shorter. There were 4 (0.4%) cerebrovascular events in the consultant group and 3 (0.6%) in the trainee group. Postoperative stay was shorter in the trainee group (7.19 vs. 7.97 days, p = 0.033). Other complication rates were similar. Conclusions: The technique has excellent outcomes, especially neurological, and is safe for training junior surgeons.