Background The prognosticimpactofcross-clamptime(XCT)inpatientsundergoingisolatedcoronaryarterybypass grafting (CABG)hasnotbeenthoroughlyinvestigated. Material and Methods 2957 patientswhounderwenton-pumpisolatedCABGfromtheprospectivemulticentreE-CABGstudy were thesubjectsofthisanalysis. The meanXCTinthisserieswas58 25 [21TD$DIF]minutes Cross-clamptimewas >60 [2TD$DIF]minutes in1134patients (38.3%), >75 [2TD$DIF]minutes in619patients(20.9%)and >90 [2TD$DIF]minutes in296patients(10.0%).Multivariateanalysis showed thatXCTwasanindependentpredictorof30-daymortality(p < 0.0001, OR1.027,95%CI1.015– 1.039) alongwithage(p < 0.0001), femalegender(p=0.001),pulmonarydisease(p=0.001),poormobility (p =0.002),urgencystatus(p=0.007),criticalpreoperativestatus(p=0.002)andparticipatingcentres (p =0.015).Adjustedriskof30-daymortalitywashighestforXCT >75 [2TD$DIF]minutes (2.9%vs.1.7%,p=0.002, OR 3.479,95%CI1.609–7.520).Analysisof428propensityscorematchedpairsshowedthatXCT >75 [2TD$DIF] minutes wasassociatedwithsignificantlyincreasedriskofearlymortality,prolongeduseofinotropes, postoperative useofintra-aorticballoonpump,useofextracorporealmembraneoxygenation,atrialfibrilla- tion, prolongedstayintheintensivecareunitandofcompositemajoradverseevents. Conclusions Isolated CABGiscurrentlyperformedwithprolongedXCTinasignificantnumberofpatientsandthis seems tobeadeterminantofpoorearlyoutcome.
Prognostic Impact of Prolonged Cross-Clamp Time in Coronary Artery Bypass Grafting / Ruggieri, V.g., Bounader, K., Verhoye, J.p., Onorati, F., Rubino, A.s., Gatti, G., Tauriainen, T., De Feo, M., Reichart, D., Dalén, M., Svenarud, P., Faggian, G., Santarpino, G., Maselli, D., Gherli, R., Mariscalco, G., Salsano, A., Nicolini, F., Gherli, T., Saccocci, M., et al.. - In: HEART LUNG & CIRCULATION. - ISSN 1443-9506. - 27:12(2018), pp. 1476-1482. [10.1016/j.hlc.2017.09.006]
Prognostic Impact of Prolonged Cross-Clamp Time in Coronary Artery Bypass Grafting.
Nicolini F;Gherli T;
2018-01-01
Abstract
Background The prognosticimpactofcross-clamptime(XCT)inpatientsundergoingisolatedcoronaryarterybypass grafting (CABG)hasnotbeenthoroughlyinvestigated. Material and Methods 2957 patientswhounderwenton-pumpisolatedCABGfromtheprospectivemulticentreE-CABGstudy were thesubjectsofthisanalysis. The meanXCTinthisserieswas58 25 [21TD$DIF]minutes Cross-clamptimewas >60 [2TD$DIF]minutes in1134patients (38.3%), >75 [2TD$DIF]minutes in619patients(20.9%)and >90 [2TD$DIF]minutes in296patients(10.0%).Multivariateanalysis showed thatXCTwasanindependentpredictorof30-daymortality(p < 0.0001, OR1.027,95%CI1.015– 1.039) alongwithage(p < 0.0001), femalegender(p=0.001),pulmonarydisease(p=0.001),poormobility (p =0.002),urgencystatus(p=0.007),criticalpreoperativestatus(p=0.002)andparticipatingcentres (p =0.015).Adjustedriskof30-daymortalitywashighestforXCT >75 [2TD$DIF]minutes (2.9%vs.1.7%,p=0.002, OR 3.479,95%CI1.609–7.520).Analysisof428propensityscorematchedpairsshowedthatXCT >75 [2TD$DIF] minutes wasassociatedwithsignificantlyincreasedriskofearlymortality,prolongeduseofinotropes, postoperative useofintra-aorticballoonpump,useofextracorporealmembraneoxygenation,atrialfibrilla- tion, prolongedstayintheintensivecareunitandofcompositemajoradverseevents. Conclusions Isolated CABGiscurrentlyperformedwithprolongedXCTinasignificantnumberofpatientsandthis seems tobeadeterminantofpoorearlyoutcome.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
