Our Summary

This study looked at how the length of time spent on a heart-lung machine (also called cardiopulmonary bypass or CPB) during specific heart surgery (CABG) could affect patients’ outcomes after surgery. The research analyzed data from 1960 patients who had this surgery between 2009 and 2014.

The study found that if the total time on the CPB machine was more than 180 minutes, it significantly increased the likelihood of the patient dying after surgery. This was even after considering other risk factors and potential post-surgery complications.

In addition, if the time on the CPB machine per graft (a portion of the surgery) was more than 56 minutes, it didn’t directly increase the risk of death, but it did increase the chance of complications, a longer stay in the intensive care unit, and a longer need for mechanical ventilation (breathing support), which could indirectly lead to a higher risk of death.

The researchers suggest that to lower the risk of these negative outcomes, the time on the CPB machine should ideally be kept under 56 minutes per graft and under 180 minutes in total.

FAQs

  1. What is the link between the time spent on a heart-lung machine during surgery and patient outcomes?
  2. How does the length of time on the CPB machine per graft affect the patient’s risk of complications and death?
  3. What recommendations do researchers make to lower the risk of negative outcomes after heart surgery?

Doctor’s Tip

Therefore, a helpful tip that a doctor might give a patient undergoing heart bypass surgery is to discuss with their surgical team the possibility of minimizing the time spent on the heart-lung machine during surgery. This could potentially lead to better outcomes and a smoother recovery post-surgery. It’s important for patients to advocate for their own health and discuss all possible options with their healthcare team.

Suitable For

Patients who are recommended for heart bypass surgery (CABG) typically have severe coronary artery disease that cannot be managed effectively with medication or less invasive procedures. They may have blockages in multiple coronary arteries, leading to symptoms such as chest pain (angina) or shortness of breath. Patients with a high risk of heart attack, heart failure, or other serious complications due to their heart disease may also be recommended for bypass surgery.

Additionally, patients who have already had a heart attack or have other health conditions that increase their risk of complications during surgery, such as diabetes, kidney disease, or peripheral artery disease, may be candidates for heart bypass surgery. The decision to recommend bypass surgery is made on a case-by-case basis by a team of cardiac surgeons, cardiologists, and other healthcare providers based on the individual patient’s medical history, symptoms, and overall health status.

Timeline

  • Before heart bypass surgery: The patient will undergo various tests and evaluations to determine the need for surgery, such as an angiogram, echocardiogram, and blood tests. They will also meet with their surgical team to discuss the procedure, risks, and recovery process.

  • Day of surgery: The patient will be admitted to the hospital and prepared for surgery, which typically lasts several hours. During the surgery, the patient is connected to a heart-lung machine to circulate blood and oxygen throughout the body while the heart is stopped for the bypass procedure.

  • Immediately after surgery: The patient will be transferred to the intensive care unit (ICU) for monitoring and recovery. They may be on a ventilator to help with breathing and will have various tubes and monitors attached to them.

  • Post-surgery recovery: The patient will gradually be weaned off the ventilator and other tubes as they regain strength and function. They will begin physical therapy and other rehabilitation activities to aid in recovery and prevent complications.

  • Follow-up care: The patient will have regular follow-up appointments with their surgical team to monitor their progress, manage medications, and address any concerns or complications that may arise.

  • Long-term recovery: The patient will need to make lifestyle changes, such as diet and exercise, to improve their heart health and prevent future heart issues. They may also need to take medications to manage their condition and attend cardiac rehabilitation programs to support their recovery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about heart bypass surgery in light of this study include:

  1. How long do you anticipate I will be on the heart-lung machine during my surgery?
  2. What measures will be taken to minimize the time I spend on the heart-lung machine?
  3. What is the average time spent on the heart-lung machine for patients undergoing this type of surgery at this hospital?
  4. What are the potential risks and complications associated with an extended time on the heart-lung machine?
  5. How will you monitor my condition during and after surgery to ensure the best possible outcome?
  6. Will my specific health condition or medical history impact the length of time I spend on the heart-lung machine?
  7. Are there any alternative techniques or procedures that could reduce the time I spend on the heart-lung machine?
  8. How will you ensure that I receive the appropriate post-surgery care to minimize the risk of complications related to the heart-lung machine?

Reference

Authors: Madhavan S, Chan SP, Tan WC, Eng J, Li B, Luo HD, Teoh LK. Journal: J Cardiovasc Surg (Torino). 2018 Apr;59(2):274-281. doi: 10.23736/S0021-9509.17.09864-0. Epub 2017 Jul 24. PMID: 28741335