Is There an Upper Limit to Cardiopulmonary Bypass Times?

• Main Authors: Saad Rustum (Author), Felix Fleissner (Author), Erik Beckmann (Author), Fabio Ius (Author), Mathias Wilhelmi (Author), Serghei Cebotari (Author), Axel Haverich (Author), Issam Ismail (Author)
• Format: Book
• Published: Annals of Circulation - Peertechz Publications, 2017-02-06.
• Subjects: Research Article
• Online Access: Connect to this object online.

<p><strong>Background: </strong>There are no safe operations in cardiac surgery. Every operation can possibly go wrong. We therefore retrospectively evaluated all cardiac operations lasting more than 300 minutes of bypass time at our institution to evaluate outcome and factors relevant for perioperative mortality and morbidity. <br></p><p><strong>Methods: </strong>We retrospectively included patients receiving cardiac operations or operations at the great vessels with cardiopulmonary bypass times above 300 minutes operated from 1/1/1996 until 12/1/2012 in our study. Patients receiving lung or heart or combined heart and lung transplantations were excluded from our study. 240 patients were included in our study. CPB times, clamp times and operation times were 356.53 ± 55.06 min, 166.18± 65.95 min, 500.47± 96.56 min respectively. Euro score of patients was 4.92 ± 15.35 (range 0.64-79.48). <br></p><p><strong>Results: </strong>Intraoperative and in-hospital mortality was 11.7% (n=28) and 32.9% (n=79), respectively. Overall mortality was 50.4%. Complication rates were high. Stroke, postoperative dialysis, re-thoracotomy rates were 11.1% (n=24), 35.9% (n=78) and 30.4% (n=66), respectively. Sex, age, infectious endocarditis, need for re-thoracotomy, CABG, aortic clamp times and postoperative dialysis predicted overall mortality in the multivariate analysis. CPB times and operation times were no independent predictors for overall mortality in this collective. In the patients collective excluding the intraoperative deaths, multivariate analysis revealed postoperative lactate levels, amylase levels, and intraoperative need for thrombcyte concentrates and ECMO support to be predictors of mortality. The introduction of reliable ECMO support (general availability starting in 2009) resulted in a signifi cant reduction of intraoperative mortality and overall mortality (p<0.001). <br></p><p><strong>Conclusion: </strong>Very long CPB times due to intraoperative encountered complications can occur at any given Euroscore. They are associated with a high mortality and morbidity, however even bypass times of over 500 minutes can be survived. The introduction of the ECMO reduced intraoperative mortality however, had no impact on in-hospital mortality.</p>