Key result
Shorter aortic cross-clamp time during CABG reduces post-operative CKMB ~30% versus longer times.
Why the study?
The impact of shorter versus longer aortic cross clamp time on cardiac enzyme levels and associated morbidity in patients undergoing CABG was unclear in the local population.
Does a shorter aortic cross clamp time (<60 minutes) reduce cardiac enzyme levels compared to a longer cross clamp time (>60 minutes) in patients undergoing CABG?
RCT (n=300)
Randomized
No
Does a shorter aortic cross clamp time (<60 minutes) reduce cardiac enzyme levels compared to a longer cross clamp time (>60 minutes) in patients undergoing CABG?
Absolute Event Rate: 26.89% vs 38.51%
p-value: p=<0.001
Shorter aortic cross clamp time (<60 minutes) during CABG is associated with significantly reduced cardiopulmonary bypass time compared to longer cross clamp times.
Shorter cross-clamp time reduces post-CABG cardiac enzyme elevation; reinforces clamp duration as independent morbidity predictor in RCT evidence.
Aim: To compare mean cardiac enzyme levels in of shorter cross clamp time V/S longer cross Clamp time in patients undergoing CABG in local population. Study Design: Randomized Controlled Trial Place and duration: This study was performed from 2nd April 2020 to 2nd October 2020 in the Department of Cardiac Surgery Punjab Institute of Cardiology, Lahore. Methodology: After informed consent, all patients undergoing CABG were enrolled and divided into two groups. A predesigned performa was used to enter preop, intra op and post op variables and cardiac enzyme levels were compared between shorter (<60 minutes) and longer (>60 minutes) aortic cross clamp time groups. Results: Study had enrolled 300 patients and 150(50%) patients were designated group A (shorter cross clamp time and 150 (50%) patients were designated in group B (longer cross clamp time). Out of these 300, 246 patients (82%) were males and 54 (18%) were females. Extremes of age were 70 years and 37 years and mean age was 56.77±8.03 years. Group A (shorter cross clamp time) patients had mean age of 56.64 ±7.53 and group B (longer cross clamp time) patients had 56.89±8.52 .Mean EF (%) was 52.17±8.98 with 23% being minimum and 70% being maximum. In group A patients, 93 patients (62%) were hypertensive , 82(55%) were smokers and 67 (45%) patients were diabetic, while group B had 110 (73%) hypertensive, 84(56%) smokers and 73(49%) diabetic patients. Mean CPB time in group A was recorded to be 93.72±29.97 and mean CPB time in group B was 121.04±31.83. The P-value was 0.001, significant enough to represent difference in CPG time in both groups Practical Implication: Additionally, no notable difference was found in need of inotropic supports between two groups. Longer cross clamp time is also associated with longer CPB time which in turn correlates with higher morbidity and mortality. Conclusion: It is concluded that prolonged cross clamp time is an independent predictor of morbidity despite cardio protection by modern strategies Keywords: CKMB, IABP, CABG, CPB time, aortic cross clamp time, Shorter Cross
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Arif et al. (2023) conducted an RCT in Coronary Artery Disease (n=300). Shorter aortic cross clamp time (<60 minutes) vs. Longer aortic cross clamp time (≥60 minutes) was evaluated on Post-operative CKMB levels (IU/L) (p=<0.001). Shorter aortic cross clamp time (<60 minutes) during CABG significantly reduced post-operative CKMB levels (26.89 vs 38.51 IU/L) and Troponin I levels compared to longer cross clamp times.
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