Use of clampless facilitating devices in patients with low-grade aortic disease: is the cost justified by the theoretic risk reduction?

I appreciate the commentary of Formica and colleagues regarding the use of clampless facilitating devices (CFDs) in patients undergoing coronary artery bypass grafting (CABG). The quest to reduce stroke after CABG has led to numerous observational and prospective trials with a variety of approaches, including off-pump CABG, anaortic approaches, hybrid revascularization, and CFDs. With regard to my group's recent prospective, randomized trial,1 we agree with Formica and colleagues that there were limitations with our study, specifically that the primary end point was a surrogate for stroke, transcranial Doppler high-intensity transient signals (HITS) rather than a hard clinical end point.

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