Prolonged Cross-Clamping During Aortic Valve Replacement Is an Independent Predictor of Postoperative Morbidity and Mortality: Analysis of the Japan Cardiovascular Surgery Database

Background. The present study aimed to determine whether aortic cross-clamp duration (ACCD) was directly related to postoperative morbidity and mortality rates and to identify the inflection point of ACCD for increased mortality and morbidity rates in patients who had undergone isolated aortic valve replacement (AVR) for aortic stenosis. Methods. From the Japan Cardiovascular Surgery Database, we extracted data from 16,272 patients with AS who underwent isolated AVR between January 2008 and December 2012. We evaluated postoperative mortality and morbidity rates after stratifying patients into five groups based on ACCD (<60 minutes, >= 60 to <90 minutes, >= 90 to <120 minutes, >= 120 to <150 minutes, and >= 150 minutes). Results. The overall hospital mortality rate was 2.8%. Multivariate logistic analysis revealed that the odds ratio for operative mortality increased as ACCD incrementally increased and was markedly higher for ACCD of 150 minutes or longer (odds ratio, 2.68; 95% confidence interval, 1.66 to 4.32; p < 0.001). There were significant increases in risks of reoperation for bleeding for ACCD of120 minutes or longer, stroke for ACCD of 60 minutes or longer, deep sternal infection for ACCD of 120 minutes or longer, ventilation for more than 24 hours for ACCD of 90 minutes or longer, and new requirement for dialysis for ACCD of 150 minutes or longer. Conclusions. Prolonged ACCD offers an independent predictor of postoperative morbidity and mortality after isolated AVR for AS despite recent technologic advances and surgical refinements. (C) 2017 by The Society of Thoracic Surgeons