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The Journal of Cardiovascular Surgery 2018 April;59(2):274-81

DOI: 10.23736/S0021-9509.17.09864-0

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

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


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BACKGROUND: This study was conducted to examine the impact of CPB times on postoperative 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 1960 patients who had undergone isolated on-pump CABG from 2009 to 2014 were analyzed. The risk strata of cardiopulmonary bypass (CPB)/graft and cumulative CPB times, identified with a decision tree, were added into an augmented model for predicting short- and intermediate-term postoperative clinical events.
RESULTS: Prolonged cumulative CPB time (>180 minutes) was significant in predicting mortality while adjusting for EuroSCORE II, postoperative 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 postoperative 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: Coronary artery bypass - Outcome assessment, health care - Mortality

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