Sudharsan Madhavan1, Siew-Pang Chan2,3,4, Wei-Chuan Tan1, Jolane Eng5, Bowen Li5, Hai-Dong Luo5, Leok-Kheng K Teoh6,5. 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. 6. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore - kristine_lk_teoh@nuhs.edu.sg.
Abstract
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.
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.
Authors: Mbakise P Matebele; Mahesh Ramanan; Kelly Thompson; George Cornmell; Rishendran V Naidoo; Kiran Shekar Journal: Crit Care Explor Date: 2020-07-15
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