University of Oulu

Vito G. Ruggieri, Karl Bounader, Jean Philippe Verhoye, Francesco Onorati, Antonino S. Rubino, Giuseppe Gatti, Tuomas Tauriainen, Marisa De Feo, Daniel Reichart, Magnus Dalén, Peter Svenarud, Giuseppe Faggian, Giuseppe Santarpino, Daniele Maselli, Riccardo Gherli, Giovanni Mariscalco, Antonio Salsano, Francesco Nicolini, Tiziano Gherli, Matteo Saccocci, Juhani K.E. Airaksinen, Sidney Chocron, Andrea Perrotti, Fausto Biancari, Prognostic Impact of Prolonged Cross-Clamp Time in Coronary Artery Bypass Grafting, Heart, Lung and Circulation, Volume 27, Issue 12, 2018, Pages 1476-1482, ISSN 1443-9506,

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)
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Language: English
Published: Elsevier, 2018
Publish Date: 2019-10-22


Background: 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.

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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
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
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