Abdominal Decompression after Cardiac Surgery: Outcome of 42 Patients with Abdominal Compartment Syndrome

Abstract

Background Up to 50% of patients in intensive care units develop intraabdominal hypertension (IAH) in the course of medical treatment. If not detected on time and treated adequately, IAH may develop into an abdominal compartment syndrome (ACS) which is associated with a high mortality rate. Patients undergoing cardiac surgery are especially prone to develop ACS due to several risk factors including intraoperative hypothermia, fluid resuscitation and acidosis. We investigated patients who developed ACS after cardiac surgery and analyzed potential risk factors, treatment and outcome. Methods From 2011 to 2016, patients with ACS after cardiac surgery requiring decompressive laparotomy were prospectively recorded. Patient characteristics, details on the cardiac surgery, mortality rate and type of treatment of the open abdomen were analyzed. Results Incidence of ACS in cardiac surgery patients was 1.0% (n = 42/4128), with a mortality rate of 57%. Ejection fraction, Euroscore2 as well as the perfusion time are independent risk factors for the development of ACS. The outcome of patients with ACS was independent of elective versus emergency surgery, gender, age, BMI or ASA score. In the 18 surviving patients, fascial closure was achieved in 72% after a median of 9 days. Conclusion Abdominal compartment syndrome is a rare but serious complication after cardiac surgery with a high mortality rate. Independent risk factors for ACS were identified. Negative pressure wound therapy seems to promote and allow early fascia closure of the abdomen and represents therefore a likely benefit for the patient.

Impact of Obesity on Clinical Outcomes of Patients with Intra-Abdominal Hypertension and Abdominal Compartment Syndrome

“…Subsequently, 126 articles were assessed for eligibility via full-text screening, of which 117 articles were further excluded ( Figure 1 ). The final systematic review included nine articles [ 8 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ].…”

Automated Intra-abdominal Pressure Monitoring During Orthotopic Heart Transplant Leads to Early Diagnosis and Treatment of Intraoperative Abdominal Compartment Syndrome—A Case Report

“…However, none of these patients progressed to ACS, possibly due to underpowering of these studies (138 and 69 patients, respectively) (7,9). The incidence and outcomes of perioperative ACS in cardiac surgical patients are less well-described (10)(11)(12)(13). Recently, a prospective observational multicenter study reported one percent of cardiac surgery patients developed ACS post-operatively and require decompressive laparotomy, with significant associated mortality of 57% (13).…”

“…The incidence and outcomes of perioperative ACS in cardiac surgical patients are less well-described (10)(11)(12)(13). Recently, a prospective observational multicenter study reported one percent of cardiac surgery patients developed ACS post-operatively and require decompressive laparotomy, with significant associated mortality of 57% (13). We could only identify two prior case reports describing the development of intraoperative ACS during cardiac surgery: (1) secondary ACS during failure to maintain CPB while undergoing elective minimally invasive right mini-thoracotomy mitral valve and tricuspid valve repairs (14).…”

Massive Ascites Causing Presumed Abdominal Compartment Syndrome During Open Heart Surgery With Cardiopulmonary Bypass

“…Although increases in IAP occur more commonly in the post-operative period, increases in IAP are known to occur during cardiopulmonary bypass (CPB) and have been implicated in the development of renal failure and mesenteric vascular dysfunction [1,[3][4][5][6][7][8]. The literature on catastrophic IAH and ACS in cardiac surgery, however, is limited to case reports and small studies [9][10][11][12][13]. In one study, the incidence of ACS in cardiac surgery was determined to be about 1% [13].…”

“…The literature on catastrophic IAH and ACS in cardiac surgery, however, is limited to case reports and small studies [9][10][11][12][13]. In one study, the incidence of ACS in cardiac surgery was determined to be about 1% [13]. The definitive cause(s) of ACS and catastrophic IAH is not known and remain subject to investigation [2,7,8,[10][11][12].…”