John Chalmers1, Mark Pullan1, Neeraj Mediratta1, Michael Poullis2. 1. Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK. 2. Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK mpoullis@hotmail.com.
Abstract
OBJECTIVES: To determine in the modern era if cardiopulmonary bypass (CPB) time has a significant effect on postoperative morbidity, mortality and long-term survival in patients undergoing isolated aortic valve replacement (AVR) surgery. METHODS: Analysis of a prospectively collected cardiac surgery database was performed. Uni- and multivariate analysis on the need of resternotomy for bleeding, mediastinal blood loss, intensive care unit (ICU) length of stay, hospital length of stay, in-hospital mortality and long- term survival was performed. Only patients with a cross-clamp time <90 min were analysed to exclude technical issues confounding the results. RESULTS: A total of 1863 isolated first-time AVR procedures were analysed, with an in-hospital mortality rate of 2.4%. The rate of long-term follow-up achieved was 100%. Univariate analysis revealed that CPB time (minutes) had no significant effect on resternotomy (P = 0.5), creatinine kinase muscle-brain isoenzyme (CKMB) release (P = 0.8) and long-term survival (P = 0.06), but was significantly associated with mediastinal blood loss (P = 0.01), ICU length of stay (P = 0.02), hospital length of stay (P = 0.03) and in-hospital mortality (P < 0.001). Multivariate analysis identified that bypass time (min) was a significant factor associated with mediastinal blood loss (P < 0.001), ICU length of stay (P = 0.01), postoperative length of stay (P < 0.001) and in-hospital mortality (odds ratio [OR] 1.02, 95% CI 1.01-1.04, P = 0.01), but not long-term survival. Multivariate analysis identified that era of surgery had no significant effect on CKMB release (P = 0.2), mediastinal blood loss (P = 0.4) and in-hospital mortality (P = 0.9), but the latter era of this study was significantly associated with a reduced postoperative length of stay (P < 0.001), reduced ICU length of stay (P < 0.001), reduced need for resternotomy for bleeding (OR 0.62, 95% CI 0.41-0.94, P = 0.02) and improved long-term survival (hazard ratio 0.76, 95% CI 0.59-0.96, P = 0.02). Adjusting for era made no difference with respect to the above study findings. CONCLUSIONS: Despite improvements over time with regard to morbidity, mortality and long-term survival, CPB time remains a significant factor determining mediastinal blood loss, ICU and hospital length of stay, and in-hospital mortality.
OBJECTIVES: To determine in the modern era if cardiopulmonary bypass (CPB) time has a significant effect on postoperative morbidity, mortality and long-term survival in patients undergoing isolated aortic valve replacement (AVR) surgery. METHODS: Analysis of a prospectively collected cardiac surgery database was performed. Uni- and multivariate analysis on the need of resternotomy for bleeding, mediastinal blood loss, intensive care unit (ICU) length of stay, hospital length of stay, in-hospital mortality and long- term survival was performed. Only patients with a cross-clamp time <90 min were analysed to exclude technical issues confounding the results. RESULTS: A total of 1863 isolated first-time AVR procedures were analysed, with an in-hospital mortality rate of 2.4%. The rate of long-term follow-up achieved was 100%. Univariate analysis revealed that CPB time (minutes) had no significant effect on resternotomy (P = 0.5), creatinine kinase muscle-brain isoenzyme (CKMB) release (P = 0.8) and long-term survival (P = 0.06), but was significantly associated with mediastinal blood loss (P = 0.01), ICU length of stay (P = 0.02), hospital length of stay (P = 0.03) and in-hospital mortality (P < 0.001). Multivariate analysis identified that bypass time (min) was a significant factor associated with mediastinal blood loss (P < 0.001), ICU length of stay (P = 0.01), postoperative length of stay (P < 0.001) and in-hospital mortality (odds ratio [OR] 1.02, 95% CI 1.01-1.04, P = 0.01), but not long-term survival. Multivariate analysis identified that era of surgery had no significant effect on CKMB release (P = 0.2), mediastinal blood loss (P = 0.4) and in-hospital mortality (P = 0.9), but the latter era of this study was significantly associated with a reduced postoperative length of stay (P < 0.001), reduced ICU length of stay (P < 0.001), reduced need for resternotomy for bleeding (OR 0.62, 95% CI 0.41-0.94, P = 0.02) and improved long-term survival (hazard ratio 0.76, 95% CI 0.59-0.96, P = 0.02). Adjusting for era made no difference with respect to the above study findings. CONCLUSIONS: Despite improvements over time with regard to morbidity, mortality and long-term survival, CPB time remains a significant factor determining mediastinal blood loss, ICU and hospital length of stay, and in-hospital mortality.
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