Gastrointestinal Complications after Cardiopulmonary Bypass: Sixteen Years of Experience

Bolcal, Cengiz; Iyem, Hikmet; Sarğın, Murat; Mataracı, İlker; Şahin, Mehmet; Temizkan, Veysel; Yıldırım, Vedat; Demirkılıç, Ufuk; Tatar, Harun

doi:10.1155/2005/975612

Cited by 34 publications

(40 citation statements)

References 17 publications

(23 reference statements)

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“…[1][2][3][4][5][6][7][8] In our study, the incidence of GI complications in patients undergoing mitral valve surgery was 2.3% with a 30-day mortality of 39%, both of which consistent with existing reports. Valvular surgery was suggested to correlate with higher incidence of GI complications both by univariate [9][10][11][12][13] and multivariate 3,14) analysis, and our incidence is in agreement with this observation.…”

Section: Discussionsupporting

confidence: 89%

“…Low flow state often requires placement of IABP which has been identified as a determining factor for abdominal complications in both multivariate 7,14,17) and univariate studies. 2,3,6,8,10,13,20) In our analysis, although postoperative IABP use was significantly more common in the GI complications group by univariate analysis ( Table 1), its impact after logistical regression analysis was not significant.…”

Section: Discussionmentioning

confidence: 53%

“…However, mortality in these patients is high, ranging from 11%-70% in various studies. [1][2][3][4][5][6][7][8] Multiple published reports have examined GI complications after cardiac surgery in general. This represents a heterogeneous group of pathologies.…”

Section: Introductionmentioning

confidence: 99%

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Gastrointestinal Complications after Mitral Valve Surgery

Gulkarov

Trocciola

Yokoyama

et al. 2014

Ann Thorac Cardiovasc Surg

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Introduction: Gastrointestinal (GI) complications are well-recognized risks of open heart surgery. However, open heart surgery comes in different shapes and sizes with widely varying pre-operative, intra-operative and post-operative pathologies. The aim of this study was to examine the etiology and risk factors for GI complications after mitral valve surgery. Methods: A retrospective analysis of 565 patients who underwent mitral valve surgery from 2003-2005 was performed. Prospectively collected data included preoperative risk factors, cardiac status, intra-operative data, postoperative GI complications and mortality. Survival was analyzed using log-rank analysis. Results: In this study population, 13 patients (2.3%) had 16 GI complications after mitral valve surgery resulting in an overall mortality of 0.7%. Complications included GI bleed (n = 9), cholecystitis (n = 3), perforated diverticulitis (n = 1) and ischemic bowel (n = 3). By univariate analysis, a history of hypertension, chronic renal insufficiency (CRI), hypercholesterolemia, myocardial infarction, congestive heart failure, cardiogenic shock, emergency valve surgery, coronary artery bypass surgery and preoperative vasopressor use were each associated with an increased incidence of GI complications (p <0.05). No increased incidence was seen in patients with atrial fibrillation. On multivariate analysis adjusted for age, cardiogenic shock (OR 8.1; 95% CI, 1.9-34.8), CRI (OR 8.1; 95% CI, 2.2-30.0) and vasopressor use (OR 6.5; 95% CI, 1.3-31.0) remained significant (p <0.02). Mean survival (3.2 vs. 5.4 years) was significantly lower (p <0.05) in those with GI complications. Conclusions: GI complications after mitral valve surgery are infrequent, with a higher incidence in those with cardiogenic shock, CRI or requiring vasopressors. Pre-operative hemodynamic instability may be a bellwether for potential GI complications and should be of more prominent concern in this cohort of patients.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 53%

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Gastrointestinal Complications after Mitral Valve Surgery

Gulkarov

Trocciola

Yokoyama

et al. 2014

Ann Thorac Cardiovasc Surg

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“…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] .…”

Section: Ami After Cpbmentioning

confidence: 99%

“…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] . Pathophysiology AMI occurring after CPB, is due to NOMI in the vast majority of cases [137][138][139] .…”

Section: Ami After Cpbmentioning

confidence: 99%

Acute mesenteric ischemia after cardio-pulmonary bypass surgery

Abboud¹,

Daher²,

Boujaoude³

2008

WJG

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Acute mesenteric ischemia (AMI) is a highly-lethal surgical emergency. Several pathophysiologic events (arterial obstruction, venous thrombosis and diffuse vasospasm) lead to a sudden decrease in mesenteric blood flow. Ischemia/reperfusion syndrome of the intestine is responsible for systemic abnormalities, leading to multi-organ failure and death. Early diagnosis is difficult because the clinical presentation is subtle, and the biological and radiological diagnostic tools lack sensitivity and specificity. Therapeutic options vary from conservative resuscitation, medical treatment, endovascular techniques and surgical resection and revascularization. A high index of suspicion is required for diagnosis, and prompt treatment is the only hope of reducing the mortality rate. Studies are in progress to provide more accurate diagnostic tools for early diagnosis. AMI can complicate the post-operative course of patients following cardio-pulmonary bypass (CPB). Several factors contribute to the systemic hypo-perfusion state, which is the most frequent pathophysiologic event. In this particular setting, the clinical presentation of AMI can be misleading, while the laboratory and radiological diagnostic tests often produce inconclusive results. The management strategies are controversial, but early treatment is critical for saving lives. Based on the experience of our team, we consider prompt exploratory laparotomy, irrespective of the results of the diagnostic tests, is the only way to provide objective assessment and adequate treatment, leading to dramatic reduction in the mortality rate.

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Putting It All Together

Houser

2009

The Operated Heart at Autopsy

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Gastrointestinal Complications after Cardiopulmonary Bypass: Sixteen Years of Experience

Abstract: GI complications remain a significant concern after cardiac surgery under cardiopulmonary bypass. Higher-risk patients can be identified and treated prophylactically and in the postoperative period.

Cited by 34 publications

References 17 publications

Gastrointestinal Complications after Mitral Valve Surgery

Gastrointestinal Complications after Mitral Valve Surgery

Acute mesenteric ischemia after cardio-pulmonary bypass surgery

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