Operative Strategies to Reduce Cerebral Embolic Events During On- and Off-Pump Coronary Artery Bypass Surgery: A Stratified, Prospective Randomized Trial

In this study the authors randomized 142 patients within two separate treatment arms:  (1) Patients undergoing on-pump CABG were randomized to either a single- vs. double-clamp technique for proximals; (2)  patients undergiong OPCAB were randomized to either a Heartstring device or single clamp for proximals.  For all 4 treatment groups, the number of embolic HITS was assessed with transcranial doppler of the middle cerebral artery.

Results:

(1)  On-pump CABG:  The mean number of HITS in the single-clamp group was 10.0, while that for the double-clamp group was 16.0 (p=.10). (Although the difference was not significant, the treatment groups were rather small.)

(2)  OPCAB:  The mean number of HITS in the Heartstring group was 30.0, whereas that for the partial clamp group was 7.0 (p<.0001).  Thus, the Heartstring group had more than 4 times the embolic load by TCD.

Notably, neurocognitive outcomes were not different among the groups.