Clinically Diagnosed Nonocclusive Mesenteric Ischemia after Cardiopulmonary Bypass: Retrospective Study

Abstract

This retrospective study evaluates our experience with clinically diagnosed nonocclusive mesenteric ischemia after cardiopulmonary bypass. Twenty-three of 3,600 consecutive patients suffered from splanchnic malperfusion. Symptoms developed between day 2 and 6 postoperatively in 18 of 23 patients. Four of 23 patients had no abdominal symptoms. Laboratory evaluation revealed significantly higher serum lactate and creatine phosphokinase levels in the 18 symptomatic patients compared with those of a control group. Arteriography was performed in 20 cases and revealed nonocclusive splanchnic hypoperfusion. Risk factors for development of mesenteric ischemia include arrhythmias and low cardiac output. Patients with angiographically proven nonocclusive mesenteric ischemia were treated with intra-arterial bolus injection and subsequent intra-arterial infusion of tolazoline combined with heparin sodium. The overall mortality rate was 30% (7 of 23). Infusion therapy with tolazoline and heparin seems to be a successful treatment modality for clinically diagnosed mesenteric ischemia.

Acute mesenteric ischemia after cardio-pulmonary bypass surgery

“…Incidence and frequency Abdominal complications after CPB for cardiac surgery are seen in < 1% of patients [124][125][126][127][128][129][130][131][132] but carry a high mortality of 14.1% [131] . AMI represents 10%-67% of these complications [129,133,134] , and is the most lethal, with a case-fatality rate of 70% to 100% [129,131,132,135,136] .…”

“…It has been observed that there is significant mesenteric hypoperfusion followed by hyperemic response [147] after off-pump cardiac surgery along with an increase in the resistive and pulsatility indexes [148] . Moreover, studies focusing on the identification of predisposing factors for mesenteric ischemia after CPB [135,[124][125][126] , have produced different, and even opposite results. Rare cases of embolic acute arterial infarction can be prevented when a calcified aorta is detected on pre-operative CT scan [149] .…”

“…Consequently, symptoms are not reported and the physical examination is equivocal due to masked, late-appearing, or missing clinical signs [125,139,150] . This accounts for the delay in diagnosis, and the disease may progress to a late, even irreversible stage by the time clinical signs become obvious (i.e.…”

“…Intra-arterial infusion Abboud B et al . AMI after cardiac surgery 5365 of papaverine [155] or tolazoline with heparin [125] are both effective treatments.…”

Role of Serum Lactic Acid Level in Diagnosing Mesenteric Bowel Ischemia With the Aid of the Ct Angiogram.

“…(7,23,24), during the last few years the number of prospective studies comparing the accuracy of several biomarkers were increased and demonstrated the fact that that none of the using biomarkers had the level of accuracy to be used alone as diagnostic markers. (25,26), in 2015 a study was conduct to assess the accuracy of repeated measurement of serum lactate as a marker and the authors reported that there are several factors influenced this accuracy. (12) The results of current study consistence with previous study results that serum lactate is not accurate as the doctors want and need to be combine with other markers to diagnose AMI, however still a lot of doctors rely on serum lactate as diagnostic tool due to the facts that there is no good biomarkers could replace it, it is easy to measure in any laboratory hospital and easy to repeat it .…”