Association of Cardiopulmonary Bypass and Aortic Cross-Clamp Durations with ICU Length of Stay in Cardiac Surgery Patients: A Retrospective Study at Nasiriya Heart Center
-
Hussein Ali Hussein
,
Myasar Jasim Mohammed
,
Qusay Abdulazahra Yaqoob
,
Mohammed AbdulZahra Sasaa
,
Majid Fakhir Alhamaidah
,
Hussein Alkhfaji
,
Ammar Hoom Mahdi
,
Abbass Hussein Haydar
Abstract
Background: Cardiopulmonary bypass (CPB) and aortic cross-clamping are essential components of many cardiac surgical procedures. However, prolonged durations have been linked to adverse outcomes, including delayed recovery and increased intensive care unit (ICU) resource utilization. Understanding their impact is critical for improving perioperative management and optimizing patient outcomes.
We aimed to assess how cardiopulmonary bypass time (CPBT) and aortic cross-clamp time (ACCT) affect the length of ICU stay in patients undergoing elective cardiac surgery.
Methods: Our study was retrospective clinical study which conducted at Nasiriya Heart Center, Iraq, between September 2023 and September 2024. A total of 100 patients (aged 18–65 years) who underwent elective cardiac surgery were included. Demographic data, type of surgery, admission and discharge dates, and intraoperative variables (CPBT and ACCT) were collected. Associations between CPBT, ACCT, and ICU stay were analysed by using suitable statistical approaches.
Results: Of the 100 patients, 47% were male and 53% female, with a mean age of 44 years. The mean CPBT was 112.6 ± 44.2 minutes, and the mean ACCT was 69.0 ± 34.5 minutes. Gender showed no significant effect on ICU stay. In contrast, both prolonged CPBT and ACCT were significantly associated with longer ICU stays (P = 0.047 and P = 0.005, respectively).
Conclusion: Extended CPBT and ACCT are significant predictors of prolonged ICU stay after cardiac surgery. Strategies to minimize intraoperative times may help reduce postoperative ICU occupancy and improve overall resource allocation in cardiac surgical care.
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[20] Swinkels BM, Ten Berg JM, Kelder JC, Vermeulen FE, Van Boven WJ, de Mol BA. Effect of aortic cross-clamp time on late survival after isolated aortic valve replacement. Interact Cardiovasc Thorac Surg. 2021; 32(2):222-228.
[21] Hu J, Liu Y, Huang L, Song M, Zhu G. Association between cardiopulmonary bypass time and mortality among patients with acute respiratory distress syndrome after cardiac surgery. BMC Cardiovasc Disord. 2023; 23(1):622.
[22] Delannoy B, Guye ML, Slaiman DH, Lehot JJ, Cannesson M. Effect of cardiopulmonary bypass on activated partial thromboplastin time waveform analysis, serum procalcitonin and C-reactive protein concentrations. Crit Care. 2009; 13(6):R180.
[23] Nadeem R, Agarwal S, Jawed S, Yasser A, Altahmody K. Impact of Cardiopulmonary Bypass Time on Postoperative Duration of Mechanical Ventilation in Patients Undergoing Cardiovascular Surgeries: A Systemic Review and Regression of Metadata. Cureus. 2019; 11(11):e6088.
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[25] Leening MJ, Ferket BS, Steyerberg EW, Kavousi M, Deckers JW, Nieboer D, et al. Sex differences in lifetime risk and first manifestation of cardiovascular disease: prospective population based cohort study. BMJ. 2014; 349:g5992.
[26] Santana-Cabrera L, Lorenzo-Torrent R, Sánchez-Palacios M, Martín Santana JD, Hernández Hernández JR. Influence of age in the duration of the stay and mortality of patients who remain in an Intensive Care Unit for a prolonged time. Rev Clin Esp (Barc). 2014; 214(2):74-8.
[27] Gavilanes EG, Gavilanes NL, Fleming R. The effect of age on length of stay in the medical intensive care unit. Chest. 2010; 138(4):225A.
[28] Peigne V, Somme D, Guérot E, Lenain E, Chatellier G, Fagon JY, et al. Treatment intensity, age and outcome in medical ICU patients: results of a French administrative database. Ann Intensive Care. 2016; 6(1):7.
[29] Alisher N, Khokhar RA, Rehman MU, Shaikh AS, Bux H, Sangi R. Impact of cardiopulmonary bypass time and aortic cross clamp time on immediate PostOperative outcomes in patients with congenital heart disease undergoing open heart surgery. Pak Armed Forces Med J. 2023; 73(2):443.
[30] Székely A, Sápi E, Király L, Szatmári A, Dinya E. Intraoperative and postoperative risk factors for prolonged mechanical ventilation after pediatric cardiac surgery. Paediatr Anaesth. 2006; 16(11):1166-75.
[31] Remadi JP, Rakotoarivelo Z, Marticho P, Benamar A. Prospective randomized study comparing coronary artery bypass grafting with the new mini-extracorporeal circulation Jostra System or with a standard cardiopulmonary bypass. Am Heart J. 2006; 151(1):198.
[32] Schöttler J, Lutter G, Böning A, Soltau D, Bein B, Caliebe D, et al. Is there really a clinical benefit of using minimized extracorporeal circulation for coronary artery bypass grafting?. Thorac Cardiovasc Surg. 2008; 56(02):65-70.
[33] Polito A, Patorno E, Costello JM, Salvin JW, Emani SM, Rajagopal S, et al. Perioperative factors associated with prolonged mechanical ventilation after complex congenital heart surgery. Pediatr Crit Care Med. 2011; 12(3):e122-6.
[34] Xu S, Liu J, Li L, Wu Z, Li J, Liu Y, et al. Cardiopulmonary bypass time is an independent risk factor for acute kidney injury in emergent thoracic aortic surgery: a retrospective cohort study. J Cardiothorac Surg. 2019; 14(1):90.
[2] Sarkar M, Prabhu V. Basics of cardiopulmonary bypass. Indian J Anaesth. 2017; 61(9):760-767.
[3] Hessel II EA. What's new in cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 2019; 33(8):2296-326.
[4] Machin D, Allsager C. Principles of cardiopulmonary bypass. Contin Educ Anaesth Crit Care Pain. 2006; 6(5):176-81.
[5] Komagamine M, Fukunishi T, Yamasaki Y, Tomita M, Kinebuchi S, Tomimoto D, et al. Patient Outcomes after Introduction of Novel Myocardial Protection Protocol for Prolonged Aortic Cross-Clamping. Ann Thorac Cardiovasc Surg. 2025; 31(1):25-00079.
[6] Moh'd AF, Al-Odwan HT, Altarabsheh S, Makahleh ZM, Khasawneh MA. Predictors of aortic clamp time duration and intensive care unit length of stay in elective adult cardiac surgery. Egypt Heart J. 2021; 73(1):92.
[7] Ortega-Loubon C, Fernández-Molina M, Pañeda-Delgado L, Jorge-Monjas P, Carrascal Y. Predictors of Postoperative Acute Kidney Injury after Coronary Artery Bypass Graft Surgery. Braz J Cardiovasc Surg. 2018; 33(4):323-329.
[8] De Santo LS, Rubino AS, Montella AP, Golini Petrarcone C, Palmieri L, Galbiati D, et al. Incidence and risk factors of acute kidney injury in redo cardiac surgery: a single center analysis. Sci Rep. 2024; 14(1):27267.
[9] Wang Q, Tao Y, Zhang X, Xu S, Peng Y, Lin L, et al. The Incidence, Risk Factors, and Hospital Mortality of Prolonged Mechanical Ventilation among Cardiac Surgery Patients: A Systematic Review and Meta-Analysis. Rev Cardiovasc Med. 2024; 25(11):409.
[10] Banerjee D, Feng J, Sellke FW. Strategies to attenuate maladaptive inflammatory response associated with cardiopulmonary bypass. Front Surg. 2024; 11:1224068.
[11] Rubens FD, Mesana T. The inflammatory response to cardiopulmonary bypass: a therapeutic overview. Perfusion. 2004; 19 Suppl 1:S5-12.
[12] Landis RC, Brown JR, Fitzgerald D, Likosky DS, Shore-Lesserson L, Baker RA, et al. Attenuating the Systemic Inflammatory Response to Adult Cardiopulmonary Bypass: A Critical Review of the Evidence Base. J Extra Corpor Technol. 2014; 46(3):197-211.
[13] Bronicki RA, Hall M. Cardiopulmonary Bypass-Induced Inflammatory Response: Pathophysiology and Treatment. Pediatr Crit Care Med. 2016; 17(8 Suppl 1):S272-8.
[14] Li S, Price R, Phiroz D, Swan K, Crane TA. Systemic inflammatory response during cardiopulmonary bypass and strategies. J Extra Corpor Technol. 2005; 37(2):180-8.
[15] Axtell AL, Fiedler AG, Melnitchouk S, D'Alessandro DA, Villavicencio MA, Jassar AS, et al. Correlation of cardiopulmonary bypass duration with acute renal failure after cardiac surgery. J Thorac Cardiovasc Surg. 2020; 159(1):170-178.e2.
[16] Gelman S. The pathophysiology of aortic cross-clamping and unclamping. Anesthesiology. 1995; 82(4):1026-60.
[17] Zammert M, Gelman S. The pathophysiology of aortic cross-clamping. Best Pract Res Clin Anaesthesiol. 2016; 30(3):257-69.
[18] Yeung KK, Groeneveld M, Lu JJ, van Diemen P, Jongkind V, Wisselink W. Organ protection during aortic cross-clamping. Best Pract Res Clin Anaesthesiol. 2016; 30(3):305-15.
[19] Doenst T, Berretta P, Bonaros N, Savini C, Pitsis A, Wilbring M, et al. Aortic cross-clamp time correlates with mortality in the mini-mitral international registry. Eur J Cardiothorac Surg. 2023; 63(6):ezad147.
[20] Swinkels BM, Ten Berg JM, Kelder JC, Vermeulen FE, Van Boven WJ, de Mol BA. Effect of aortic cross-clamp time on late survival after isolated aortic valve replacement. Interact Cardiovasc Thorac Surg. 2021; 32(2):222-228.
[21] Hu J, Liu Y, Huang L, Song M, Zhu G. Association between cardiopulmonary bypass time and mortality among patients with acute respiratory distress syndrome after cardiac surgery. BMC Cardiovasc Disord. 2023; 23(1):622.
[22] Delannoy B, Guye ML, Slaiman DH, Lehot JJ, Cannesson M. Effect of cardiopulmonary bypass on activated partial thromboplastin time waveform analysis, serum procalcitonin and C-reactive protein concentrations. Crit Care. 2009; 13(6):R180.
[23] Nadeem R, Agarwal S, Jawed S, Yasser A, Altahmody K. Impact of Cardiopulmonary Bypass Time on Postoperative Duration of Mechanical Ventilation in Patients Undergoing Cardiovascular Surgeries: A Systemic Review and Regression of Metadata. Cureus. 2019; 11(11):e6088.
[24] Albrektsen G, Heuch I, Løchen ML, Thelle DS, Wilsgaard T, Njølstad I, et al. Lifelong Gender Gap in Risk of Incident Myocardial Infarction: The Tromsø Study. JAMA Intern Med. 2016; 176(11):1673-1679.
[25] Leening MJ, Ferket BS, Steyerberg EW, Kavousi M, Deckers JW, Nieboer D, et al. Sex differences in lifetime risk and first manifestation of cardiovascular disease: prospective population based cohort study. BMJ. 2014; 349:g5992.
[26] Santana-Cabrera L, Lorenzo-Torrent R, Sánchez-Palacios M, Martín Santana JD, Hernández Hernández JR. Influence of age in the duration of the stay and mortality of patients who remain in an Intensive Care Unit for a prolonged time. Rev Clin Esp (Barc). 2014; 214(2):74-8.
[27] Gavilanes EG, Gavilanes NL, Fleming R. The effect of age on length of stay in the medical intensive care unit. Chest. 2010; 138(4):225A.
[28] Peigne V, Somme D, Guérot E, Lenain E, Chatellier G, Fagon JY, et al. Treatment intensity, age and outcome in medical ICU patients: results of a French administrative database. Ann Intensive Care. 2016; 6(1):7.
[29] Alisher N, Khokhar RA, Rehman MU, Shaikh AS, Bux H, Sangi R. Impact of cardiopulmonary bypass time and aortic cross clamp time on immediate PostOperative outcomes in patients with congenital heart disease undergoing open heart surgery. Pak Armed Forces Med J. 2023; 73(2):443.
[30] Székely A, Sápi E, Király L, Szatmári A, Dinya E. Intraoperative and postoperative risk factors for prolonged mechanical ventilation after pediatric cardiac surgery. Paediatr Anaesth. 2006; 16(11):1166-75.
[31] Remadi JP, Rakotoarivelo Z, Marticho P, Benamar A. Prospective randomized study comparing coronary artery bypass grafting with the new mini-extracorporeal circulation Jostra System or with a standard cardiopulmonary bypass. Am Heart J. 2006; 151(1):198.
[32] Schöttler J, Lutter G, Böning A, Soltau D, Bein B, Caliebe D, et al. Is there really a clinical benefit of using minimized extracorporeal circulation for coronary artery bypass grafting?. Thorac Cardiovasc Surg. 2008; 56(02):65-70.
[33] Polito A, Patorno E, Costello JM, Salvin JW, Emani SM, Rajagopal S, et al. Perioperative factors associated with prolonged mechanical ventilation after complex congenital heart surgery. Pediatr Crit Care Med. 2011; 12(3):e122-6.
[34] Xu S, Liu J, Li L, Wu Z, Li J, Liu Y, et al. Cardiopulmonary bypass time is an independent risk factor for acute kidney injury in emergent thoracic aortic surgery: a retrospective cohort study. J Cardiothorac Surg. 2019; 14(1):90.
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How to Cite
1.
Hussein H, Mohammed M, Yaqoob Q, Sasaa M, Alhamaidah M, Alkhfaji H, Mahdi A, Haydar A. Association of Cardiopulmonary Bypass and Aortic Cross-Clamp Durations with ICU Length of Stay in Cardiac Surgery Patients: A Retrospective Study at Nasiriya Heart Center. Arch Anesth & Crit Care. 2026;.
