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Published on: September 15, 2023
Prognostic Impact of Prolonged Cross-Clamp Time in Coronary Artery Bypass Grafting
Vito G Ruggieri1, Karl Bounader1, Jean Philippe Verhoye1
1Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France.
Insights
Prolonged cross-clamp time (XCT) during isolated coronary artery bypass grafting (CABG) is linked to increased early mortality. Strategies to minimize XCT are crucial for improving patient outcomes after CABG surgery.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Surgical Efficiency
Background:
- The prognostic significance of cross-clamp time (XCT) in isolated coronary artery bypass grafting (CABG) remains under-investigated.
- Optimizing surgical times is critical for patient safety and recovery.
Purpose of the Study:
- To investigate the association between cross-clamp time (XCT) and early outcomes in patients undergoing isolated on-pump CABG.
- To identify specific XCT thresholds associated with increased mortality and adverse events.
Main Methods:
- Analysis of 2957 patients from the prospective multicentre E-CABG study undergoing on-pump isolated CABG.
- Multivariate analysis and propensity score matching were used to assess the impact of XCT on 30-day mortality and major adverse events.
Main Results:
- Mean XCT was 58±25 minutes, with 38.3% of patients exceeding 60 minutes.
- XCT was an independent predictor of 30-day mortality (OR 1.027).
- XCT >75 minutes was associated with significantly higher adjusted risk of 30-day mortality (OR 3.479) and increased rates of major adverse events.
Conclusions:
- A significant proportion of isolated CABG procedures involve prolonged XCT.
- Prolonged XCT is a determinant of poor early outcomes, including increased mortality and complications.
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±25minutes Cross-clamp time was >60 minutes in 1134 patients (38.3%), >75minutes in 619 patients (20.9%) and >90minutes 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 >75minutes (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 >75minutes 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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