Abstract 328: The Importance of Using of Single Aortic Cross Clamp Technique to Reduce Brain Injury After Coronary Artery Bypass Grafting

Introduction: Brain injury is a common yet devastating complication of cardiac surgery. Several intra-operative practices have been identified that may reduce emboli and the systemic inflammatory response, two mediators of brain injury. Hypothesis: Practices which reduce emboli and the systemic inflammatory response will reduce brain injury Methods: We enrolled 3,994 patients undergoing coronary artery bypass grafting with or without valve surgery at eight medical centers in northern New England between 2008-2011. All procedures were performed with cardiopulmonary bypass. We studied the effect of intra-operative practices that may reduce mediators of brain injury, including: the use of: tip-to-tip coated circuits, echocardiography (transesophageal or epi-aortic), or the use of a single aortic cross-clamp. Brain injury was defined as the presence of stupor, coma, transient ischemic attack or stroke (defined as any focal neurologic deficit persisting post-operatively for more than 24 hours). Results: Brain injury was present in 7.4% (293/3994) of the patients. Adoption of practices varied, with 19.4% (765/3994) of patients receiving 1 practice, 26.0% (1024/3994) receiving 2 practices, and 34.4% (1356/3994) receiving 3 practices. Breakdown across individual practices were: 60.0% (2368/4014) coated circuits, 76.5% echocardiography (3015/4014), and 38.0% single clamp (1498/4104). Once adjusting for patient and disease characteristics and center, adoption of strategies was associated with a 15% reduced odds of brain injury (OR 0.85, ptrend 0.01). Use of a single clamp was associated with the greatest reduction in brain injury (Adj OR 0.63, p=0.02). Conclusion: While the use of any of three intra-operative practices were protective of brain injury, the use of a single clamp technique was associated with a nearly 40% reduced odds of brain injury after cardiac surgery. This analysis further confirms the benefit of a single aortic clamp approach for reducing neurologic injury.