Gastrointestinal Complications Following Cardiac Surgery

Perugini, Richard A.; Orr, Richard K.; Porter, D G; Dumas, E.; Maini, Baltej S.

doi:10.1001/archsurg.1997.01430280026003

Cited by 61 publications

(44 citation statements)

References 21 publications

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“…Supporting our hypothesis, all these factors suggest why we observed no GIS complication in either study group. It has been reported that development of GIS complications in cardiac surgery is linked with postoperative mechanical ventilation, duration of stay in the ICU, and duration of hospital stay (12). There were no differences between our study groups concerning time to extubation or time of hospital stay.…”

Section: Discussioncontrasting

confidence: 45%

Clinical significance of intestinal type fatty acid binding protein in patients undergoing coronary artery bypass surgery

Camkiran¹,

Dönmez²,

Aldemir³

et al. 2011

Anadolu Kardiyol Derg

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ÖZETAmaç: Çalışmamızın amacı, kardiyopulmoner baypas (KPB) uygulanan ve uygulanmayan (OPCAB) hastalarda intestinal iskemi ile intestinal yağ asidi bağlayıcı protein (I-FABP) arasında ilişki olup olmadığını belirlemektir. Yöntemler: Çalışma prospektif, gözlemsel olarak planlandı. Elektif koroner arter baypas greftleme cerrahisi uygulanacak 50-70 yaşları arasında hastalar ardışık olarak çalışmaya alındı. Kardiyopulmoner baypas uygulanan 35 hasta birinci grup (CPB), uygulanmayan 16 hasta ikinci grup (OPCAB) olarak kabul edildi. Gruplar arası ve grup içi karşılaştırmalar Student's t, Mann-Whitney U, Friedman ve Wilcoxon testleri ile analiz edildi. Bulgular: Kardiyopulmoner baypas uygulanan grubun I-FABP düzeylerinde operasyon sonunda, başlangıca göre anlamlı yükselme olurken (p<0.005), postoperatif 12. ve 24. saatlerde operasyon bitişine göre anlamlı düşme görüldü (sırasıyla p<0.001, p<0.001). Kardiyopulmoner baypas uygulanmayan grupta ise operasyon sonunda operasyon başlangıcına göre yükselme görülürken (p<0.001), postoperatif 24. saatte operasyon başlangıcına göre anlamlı düşme görüldü (p<0.001). Her iki grubun I-FABP düzeyleri cerrahi bitiminde preoperatif değerlere göre anlamlı şekilde yükseldi. Sonuç: Çalışmamız sırasında hiçbir hastamızda intestinal iskemi görülmezken, I-FABP düzeylerindeki değişiklik bize açık kalp cerrahisi geçiren hastalarda intestinal iskemi monitörizasyonunda I-FABP'nin kullanılabileceğini düşündürdü. ABSTRACTObjective: The aim of this study was to determine whether serum levels of intestinal type fatty acid binding protein (I-FABP) are related to intestinal ischemia in patients undergoing coronary bypass surgery. Methods: The study was planned as prospective, observational. Elective coronary artery bypass candidate patients between ages of 50 and 70 were consecutively included in the study. Thirty-five patients scheduled for cardiopulmonary bypass (CPB) were identified as the CPB group and 16 patients not scheduled for CPB were identified as the off-pump coronary artery bypass surgery (OPCAB) group. The variables between and within the groups were analyzed with Student's t, Mann-Whitney U, Friedman and Wilcoxon tests respectively. Results: In both CPB and OPCAB groups, I-FABP level at the end of the operation was significantly higher than that noted at the beginning of the operation (p<0.005). In the CPB group, there was a significant drop in I-FABP from the end of the operation to each of the postoperative time points (12 th hour and 24 th hour) (respectively p<0.001, p<0.001). In the OPCAB group, the I-FABP levels at both postoperative time points were lower than that at the end of the operation (p<0.001), and the level at 24-hour post-surgery was significantly lower than at both the end-of-operation I-FABP value (p<0.001) and the 12-hour post-surgery I-FABP value. Conclusion: Since we have not observed any intestinal ischemia through our research, slight changes of I-FABP measurements make us believe that I-FABP would be a valuable way to monitor for intestinal ischemia in patients w...

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Section: Discussioncontrasting

confidence: 45%

Clinical significance of intestinal type fatty acid binding protein in patients undergoing coronary artery bypass surgery

Camkiran¹,

Dönmez²,

Aldemir³

et al. 2011

Anadolu Kardiyol Derg

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“…Only 8 studies thus far used multivariate analysis to identify the independent determinants of GI complications in cardiac surgery. 3,7,[14][15][16][17][18][19] Although, the pathogenesis of GI lesions is complex and multifactorial, the major factor implicated in cardiac surgery is reduced systemic blood flow which is affected by multiple perioperative variables.…”

Section: Discussionmentioning

confidence: 99%

“…There are studies that favor that relationship, 14,16,18) and some that do not find a significant relationship. 15,17,19) In our analysis, although cardiopulmonary bypass (CPB) time and crossclamp time were higher in the GI complications group, they were not statistically significant both in univariate and multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

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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“…Upper gastrointestinal bleeding (UGIB) remains an important complication following cardiac surgery since, although infrequent, these complications are clinically relevant because of their associated mortality [1]. Many GI complications are reported, with only few studies addressing specifically upper GI bleeding in this context [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

“…Many GI complications are reported, with only few studies addressing specifically upper GI bleeding in this context [1][2][3]. Moreover, the generalizability of past study findings is limited by differences between the supportive cares administered over a decade ago versus today.…”

Section: Introductionmentioning

confidence: 99%

In-Hospital Nonvariceal Upper Gastrointestinal Bleeding following Cardiac Surgery: Patient Characteristics, Endoscopic Lesions and Prognosis

Amorim

Barkun

Larocque

et al. 2012

Ulcers

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Background. Nonvariceal upper gastrointestinal bleeding (NVUGIB) can occur following cardiac surgery, with sparse contemporary data on patient characteristics and predictors of outcome in this setting. Aim. To describe the clinical and endoscopic characteristics of patients with NVUGIB following cardiac surgery and characterize predictors of outcome. Methods. Retrospective review of 131 consecutive patients with NVUGIB following cardiac surgery from 2002 to 2005. Demographic characteristics, therapeutic management, and predictors of outcomes were determined. Results. 69.5% were male, mean age: 68.8 ± 10.2 yrs, mean Parsonnet score: 24.6 ± 14.2. Commonest symptoms included melena (59.4%) or coffee ground emesis (25.8%). In-hospital medications included ASA (88.5%), heparin (95.4%, low molecular weight 6.9%), coumadin (48.1%), clopidogrel (22.9%), and NSAIDS (42%). Initial hemodynamic instability was noted in 47.1%. Associated laboratory results included hematocrit 26 ± 6, platelets 243 ± 133 109/L, INR 1.7 ± 1.6, and PTT 53.3 ± 35.6 s. Endoscopic evaluation (122 patients) yielded ulcers (85.5%) with high-risk lesions in 45.5%. Ulcers were located principally in the stomach (22.5%) or duodenum (45.9%). Many patients had more than one lesion, including esophagitis (28.7%) or erosions (26.8%). 48.8% received endoscopic therapy. Mean lengths of intensive care unit and overall stays were 10.4 ± 18.4 and 39.4 ± 46.9 days, respectively. Overall mortality was 19.1%. Only mechanical ventilation under 48 hours predicted mortality (O.R = 0.11; 95% CI = 0.04−0.34). Conclusions. This contemporary cohort of consecutive patients with NVUGIB following cardiac surgery bled most often from ulcers or esophagitis; many had multiple lesions. ICU and total hospital stays as well as mortality were significant. Mechanical ventilation for under 48 hours was associated with improved survival.

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Gastrointestinal Complications Following Cardiac Surgery

Cited by 61 publications

References 21 publications

Clinical significance of intestinal type fatty acid binding protein in patients undergoing coronary artery bypass surgery

Clinical significance of intestinal type fatty acid binding protein in patients undergoing coronary artery bypass surgery

Gastrointestinal Complications after Mitral Valve Surgery

In-Hospital Nonvariceal Upper Gastrointestinal Bleeding following Cardiac Surgery: Patient Characteristics, Endoscopic Lesions and Prognosis

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