Nissinen Juha, Biancari Fausto, Wistbacka Jan-Ola, Peltola Timo, Loponen Pertti, Tarkiainen Pekka, Virkkilä Markku, Tarkka Matti
Department of Thoracic and Vascular Surgery, Vaasa Central Hospital, Vaasa, Finland.
Perfusion. 2009 Sep;24(5):297-305. doi: 10.1177/0267659109354656. Epub 2009 Dec 10.
We evaluated the impact of aortic cross-clamping time (XCT) and cardiopulmonary bypass time (CPBT) on the immediate and late outcome after adult cardiac surgery and attempted to identify their safe time limits.
This study includes 3280 patients who underwent adult cardiac surgery of various complexities. Myocardial protection was achieved with tepid continuous antegrade/retrograde blood cardioplegia.
Receiver operating characteristics (ROC) curve analysis showed that XCT (area under the curve, AUC: 0.66), CPBT (AUC: 0.73) and CPBT with unclamped aorta (AUC: 0.77) were significantly associated with 30-day postoperative mortality. XCT of increasing 30-minute intervals (Odds Ratio (OR) 1.21, 95%C.I. 1.01-1.52) and CPBT of increasing 30-minute intervals (OR 1.47, 95%C.I. 1.27-1.71) were independent predictors of 30-day mortality. The best cutoff value for XCT was 150 min (30-day death: 1.8% vs. 12.2%, adjusted OR 3.07, 95%C.I. 1.48-6.39, accuracy 91.5%) and for CPBT 240 min (30-day death: 1.9% vs. 31.5%, adjusted OR 8.78, 95%C.I. 4.64-16.61, accuracy 96.0%). These parameters were significantly associated also with postoperative morbidity, particularly with postoperative stroke.
XCT and CPBT are predictors of immediate postoperative morbidity and mortality. In our experience, cardiac procedures with CPBT<240 min and XCT<150 min were associated with a rather low risk of immediate postoperative adverse events independently of the complexity of surgery patient's operative risk.
我们评估了主动脉阻断时间（XCT）和体外循环时间（CPBT）对成人心脏手术后近期和远期结局的影响，并试图确定其安全时间限制。
本研究纳入3280例接受各种复杂程度成人心脏手术的患者。采用温和的持续顺行/逆行血液停搏液进行心肌保护。
受试者工作特征（ROC）曲线分析显示，XCT（曲线下面积，AUC：0.66）、CPBT（AUC：0.73）和主动脉未阻断时的CPBT（AUC：0.77）与术后30天死亡率显著相关。XCT每增加30分钟间隔（比值比（OR）1.21，95%置信区间1.01-1.52）和CPBT每增加30分钟间隔（OR 1.47，95%置信区间1.27-1.71）是术后30天死亡率的独立预测因素。XCT的最佳截断值为150分钟（30天死亡率：1.8%对12.2%，校正OR 3.07，95%置信区间1.48-6.39，准确率91.5%），CPBT的最佳截断值为240分钟（30天死亡率：1.9%对31.5%，校正OR 8.78，95%置信区间4.64-16.61，准确率96.0%）。这些参数也与术后并发症显著相关，尤其是与术后中风相关。
XCT和CPBT是术后近期并发症和死亡率的预测因素。根据我们的经验，CPBT<240分钟且XCT<150分钟的心脏手术与术后近期不良事件风险较低相关，与手术复杂性和患者手术风险无关。
