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THE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery


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The Journal of Cardiovascular Surgery 2017 Jul 24

DOI: 10.23736/S0021-9509.17.09864-0

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Cardiopulmonary bypass time: every minute counts

Sudharsan MADHAVAN 1, Siew-Pang CHAN 2, 3, 4, Wei-Chuan TAN 1, Jolane ENG 5, Bowen LI 5, Hai-Dong LUO 5, Leok-Kheng K. TEOH 1, 5

1 Yong Loo Lin School of Medicine, National University of Singapore, Singapore; 2 Cardiovascular Research Institute, National University Heart Centre, Singapore, Singapore; 3 Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; 4 School of Science, Health & Engineering, La Trobe University, Melbourne, Australia; 5 Department of Cardiac Thoracic and Vascular Surgery, National University Heart Centre, National University Health System, Singapore, Singapore


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BACKGROUND: This study was conducted to examine the impact of CPB times on post-operative outcomes. We sought to determine the optimum cut-offs of CPB per graft time and cumulative CPB time and their predictive accuracy for mortality in conjunction with EuroSCORE II.
METHODS: The de-identified data of 1,960 patients who had undergone isolated on-pump CABG from 2009 to 2014 were analyzed. The risk strata of CPB/graft and cumulative CPB times, identified with a decision tree, were added into an augmented model for predicting short- and intermediate-term post-operative clinical events.
RESULTS: Prolonged cumulative CPB time (>180 minutes) was significant in predicting mortality while adjusting for EuroSCORE II, post-operative complications, prolonged ICU stay and prolonged mechanical ventilation. Whereas prolonged CPB/graft time (>56 minutes) was marginally non-significant in terms of its direct effects, its indirect effect on mortality could be manifested through enhanced risks of complications, prolonged ICU stay (>48 hours) and prolonged mechanical ventilation (>24 hours).
CONCLUSIONS: Prolonged CPB times could predict post-operative clinical events, in particular mortality. To minimize the occurrence of unfavorable adverse outcomes, it is recommended that the CPB/graft time and cumulative CPB time be kept below 56 minutes and 180 minutes respectively.


KEY WORDS: CABG - Cardiopulmonary bypass time - EuroSCORE II - Outcomes

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Publication History

Article first published online: July 24, 2017
Manuscript accepted: July 24, 2017
Manuscript revised: June 20, 2017
Manuscript received: December 29, 2016

Cite this article as

Madhavan S, Chan SP, Tan WC, Eng J, Li B, Luo HD, et al. Cardiopulmonary bypass time: every minute counts. J Cardiovasc Surg 2017 Jul 24. DOI: 10.23736/S0021-9509.17.09864-0

Corresponding author e-mail

kristine_lk_teoh@nuhs.edu.sg