Correlation of preoperative factors, severity of disease, type of oxygenator and perfusion times with mortality and morbidity of coronary bypass

Abstract

Previous studies have related preoperative status and severity of disease to the outcome of coronary artery bypass surgery. Although increased perfusion and clamp times increase the risk of cardiac surgical procedures, the importance of these factors in relation to the patient's preoperative condition and the severity of disease has not previously been determined. In this study of 1078 patients, we examined the correlation between the patient's preoperative condition, the severity of coronary disease, and duration of perfusion and clamp time, and the type of oxygenator used with the mortality and morbidity associated with coronary artery bypass grafting. One-way analysis of variance and multiple correlation analysis showed that perfusion time, clamp time and nonclamp perfusion time correlated with mortality, perioperative infarction, the use of intra-aortic balloon pump, stroke, renal failure, pulmonary failure, infection, and leg wound complications (p less than 0.05). Perfusion time, clamp time and nonclamp perfusion time did not correlate with postoperative bleeding or sternal wound complications. Nonclamp perfusion time correlated more strongly than any other factor with mortality, perioperative infarction, the use of intra-aortic balloon pump, renal failure, pulmonary failure and infection (p less than 0.05). Clamp time correlated more than any other factor with the development of leg-wound complications (p less than 0.05). The use of a bubble rather than a membrane oxygenator was significantly related to mortality, stroke, infection and leg wound complications by one-way analysis of variance (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Immediate Postoperative Renal Function Deterioration in Cardiac Surgical Patients Predicts In-Hospital Mortality and Long-Term Survival

“…In our study, the in-hospital mortality rate was 3.4%, which is comparable to the mortality rate of 2.5 and 4.3% reported by others (7,8). In our group with renal function deterioration, the hospital mortality rate was 14.5%.…”

Neuroprotective Effect of Low Mean Arterial Pressure on Postoperative Cognitive Deficit Attenuated by Prolonged Coronary Artery Bypass Time: A Meta-Analysis

“…Figure 3 shows that the protective effect of low MAP can only resist up to 4 minutes of longer mean duration of high MAP. Other studies also support this finding, implying that prolonged CPB time is related to an increasing embolic load [3,23] . The pivotal role of surgery time in CABG patients has fully been understood in the literature [23-25] .…”

“…Other studies also support this finding, implying that prolonged CPB time is related to an increasing embolic load [3,23] . The pivotal role of surgery time in CABG patients has fully been understood in the literature [23-25] . Brown et al [3] reported that each 60-minute increase in CPB time associates with 30.5% increase in the embolic burden.…”

Longer Duration of Cardiopulmonary Bypass Is Associated With Greater Numbers of Cerebral Microemboli

“…[23][24][25][26][27][28][29] Both brain emboli and brain injury were found to increase with prolonged CPB. 5,9 However, because current membrane oxygenators release far fewer antifoam emboli into the blood than did bubble oxygenators, the association between CPB duration and cerebral dysfunction is likely to be weaker now.…”

“…Subsequent studies with the lipid stains oil red O and osmium demonstrated that SCADs represent microemboli that contain fat. 21,22 More than 40 reports, of which we cite 7, [23][24][25][26][27][28][29] have shown an association between cerebral dysfunction and the duration of CPB. It is also suspected that longer duration of CPB results in a greater numbers of cerebral fat emboli, but this relationship has never been clearly demonstrated.…”