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Invited Commentary
January 2016

Partial vs Single Aortic Clamping: What Is the Difference?

Author Affiliations
  • 1Surgical Service, VA St Louis Health Care System, St Louis, Missouri
  • 2Washington University School of Medicine, St Louis, Missouri
JAMA Surg. 2016;151(1):63. doi:10.1001/jamasurg.2015.3101

Once cardiopulmonary bypass became a clinical reality, the application of a noncrushing clamp across the ascending aorta allowed pioneering surgeons to correct congenital and acquired heart disease under direct vision. Favaloro et al1 described using partial aortic clamping (PAC) for proximal anastomoses for coronary operations at the Cleveland Clinic. As the mortality rate for cardiac surgery improved, a greater focus was placed on mitigating complications from poor myocardial protection and embolic neurologic injury. Single aortic clamping (SAC) arose as a strategy to mitigate both embolic stroke and inadequate myocardial protection. With the advent of off-pump coronary bypass, reducing aortic manipulation to an absolute minimum has become an ascendant strategy for the prevention of postoperative stroke. The findings of Chu et al2 challenge the primacy of this less-is-more strategy.

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