Difference Between Cardiopulmonary Bypass Time and Aortic Cross-Clamping Time as a Predictor of Complications After Coronary Artery Bypass Grafting

Author(s)

Fabiano Gonçalves Jucá ; Fabiane Letícia de Freitas ^[2] ; Maxim Goncharov ^[3] ; Daniella de Lima Pes ^[4] ; Maria Eduarda Coimbra Jucá ^[5] ; Luis Roberto Palma Dallan ^[6] ; Luiz Augusto Ferreira Lisboa ^[7] ; Fábio B. Jatene ^[8] ; Omar Asdrúbal Vilca Mejia ^[9]

• Document type: Journal article
• Source: Revista Brasileira de Cirurgia Cardiovascular; v. 39, n. 2 2024-02-23.

Abstract

ABSTRACT Introduction: Along with cardiopulmonary bypass time, aortic cross-clamping time is directly related to the risk of complications after heart surgery. The influence of the time difference between cardiopulmonary bypass and cross-clamping times (TDC-C) remains poorly understood. Objective: To assess the impact of cardiopulmonary bypass time in relation to cross-clamping time on immediate results after coronary artery bypass grafting in the Registro Paulista de Cirurgia Cardiovascular (REPLICCAR) II. Methods: Analysis of 3,090 patients included in REPLICCAR II database was performed. The Society of Thoracic Surgeons outcomes were evaluated (mortality, kidney failure, deep wound infection, reoperation, cerebrovascular accident, and prolonged ventilation time). A cutoff point was adopted, from which the increase of this difference would affect each outcome. Results: After a cutoff point determination, all patients were divided into Group 1 (cardiopulmonary bypass time < 140 min., TDC-C < 30 min.), Group 2 (cardiopulmonary bypass time < 140 min., TDC-C > 30 min.), Group 3 (cardiopulmonary bypass time > 140 min., TDC-C < 30 min.), and Group 4 (cardiopulmonary bypass time > 140 min., TDC-C > 30 min.). After univariate logistic regression, Group 2 showed significant association with reoperation (odds ratio: 1.64, 95% confidence interval: 1.01-2.66), stroke (odds ratio: 3.85, 95% confidence interval: 1.99-7.63), kidney failure (odds ratio: 1.90, 95% confidence interval: 1.32-2.74), and in-hospital mortality (odds ratio: 2.17, 95% confidence interval: 1.30-3.60). Conclusion: TDC-C serves as a predictive factor for complications following coronary artery bypass grafting. We strongly recommend that future studies incorporate this metric to improve the prediction of complications. (AU)

• FAPESP's process: 16/15163-0 - Expansion and enhancement of 'paulista cardiovascular surgery registry' through partnership with the Massachusetts State Registry/Harvard University for quality improvement programs in cardiac surgery at the São Paulo State Public Healthcare System
• Grantee: Omar Asdrúbal Vilca Mejía
• Support Opportunities: Research Grants - Research in Public Policies for the National Health Care System (PP-SUS)