Prognostic impact of prolonged cross-clamp time in coronary artery bypass grafting |
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Author: | Ruggieri, Vito G.1; Bounader, Karl1; Verhoye, Jean Philippe1; |
Organizations: |
1Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France 2Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy 3Centro Clinico-Diagnostico “G.B. Morgagni”, Centro Cuore, Pedara, Italy
4Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
5Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland 6Division of Cardiac Surgery, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy 7Hamburg University Heart Center, Hamburg, Germany 8Department of Molecular Medicine and Surgery, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden 9Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany 10Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy 11Department of Cardiovascular Sciences, Cardiac Surgery Unit, S. Camillo-Forlanini Hospital, Rome, Italy 12Department of Cardiovascular Sciences, Clinical Sciences Wing, University of Leicester, Glenfield Hospital, Leicester, UK 13Division of Cardiac Surgery, University of Genoa, Genoa, Italy 14Division of Cardiac Surgery, University of Parma, Parma, Italy 15Department of Cardiac Surgery, Centro Cardiologico–Fondazione Monzino IRCCS, University of Milan, Italy 16Heart Center, Turku University Hospital, University of Turku, Turku, Finland 17Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France 18Department of Surgery, University of Turku, Turku, Finland |
Format: | article |
Version: | accepted version |
Access: | open |
Online Access: | PDF Full Text (PDF, 0.4 MB) |
Persistent link: | http://urn.fi/urn:nbn:fi-fe2019102234263 |
Language: | English |
Published: |
Elsevier,
2018
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Publish Date: | 2019-10-22 |
Description: |
AbstractBackground: The prognostic impact of cross-clamp time (XCT) in patients undergoing isolated coronary artery bypass grafting (CABG) has not been thoroughly investigated. Material and Methods: 2957 patients who underwent on-pump isolated CABG from the prospective multicentre E-CABG study were the subjects of this analysis. Results: The mean XCT in this series was 58 ± 25 minutes Cross-clamp time was >60 minutes in 1134 patients (38.3%), >75 minutes in 619 patients (20.9%) and >90 minutes in 296 patients (10.0%). Multivariate analysis showed that XCT was an independent predictor of 30-day mortality (p < 0.0001, OR 1.027, 95%CI 1.015–1.039) along with age (p < 0.0001), female gender (p = 0.001), pulmonary disease (p = 0.001), poor mobility (p = 0.002), urgency status (p = 0.007), critical preoperative status (p = 0.002) and participating centres (p = 0.015). Adjusted risk of 30-day mortality was highest for XCT >75 minutes (2.9% vs. 1.7%, p = 0.002, OR 3.479, 95%CI 1.609–7.520). Analysis of 428 propensity score matched pairs showed that XCT >75 minutes was associated with significantly increased risk of early mortality, prolonged use of inotropes, postoperative use of intra-aortic balloon pump, use of extracorporeal membrane oxygenation, atrial fibrillation, prolonged stay in the intensive care unit and of composite major adverse events. Conclusions: Isolated CABG is currently performed with prolonged XCT in a significant number of patients and this seems to be a determinant of poor early outcome. see all
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Series: |
Heart lung and circulation |
ISSN: | 1443-9506 |
ISSN-E: | 1444-2892 |
ISSN-L: | 1443-9506 |
Volume: | 27 |
Issue: | 12 |
Pages: | 1476 - 1482 |
DOI: | 10.1016/j.hlc.2017.09.006 |
OADOI: | https://oadoi.org/10.1016/j.hlc.2017.09.006 |
Type of Publication: |
A1 Journal article – refereed |
Field of Science: |
3126 Surgery, anesthesiology, intensive care, radiology |
Subjects: | |
Copyright information: |
© 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/. |
https://creativecommons.org/licenses/by-nc-nd/4.0/ |