Gastrointestinal Emergencies in Cardiac Surgery

Vassiliou, Ioannis; Papadakis, Emmanouel; Arkadopoulos, Nikolaos; Theodoraki, Kassiani; Marinis, Athanasios; Theodosopoulos, Theodosios; Palatianos, George M.; Smyrniotis, Vassilios

doi:10.1159/000119696

Cited by 12 publications

(3 citation statements)

References 29 publications

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“…Acute renal failure, new-onset AF, myocardial infarction, stroke, and sepsis were statistically significantly more frequent in patients with GICs in the postoperative period. The length of hospital stay of patients with GIC was statistically significantly longer than that of Age (year) [2,5,8,9,[12][13][14][15][16][17]19,21,22,24,25] 4.88 Female [2][3][4][5][6][7][8][9][11][12][13][14][15][16][17][18][19][20][21][23][24][25] 0.91 Hypertension [3,5,[7][8][9]11,12,[14][15][16][18][19]…”

Section: No Gi Complicationsmentioning

confidence: 99%

Predictors and outcomes of gastrointestinal complications after cardiac surgery: A systematic review and meta-analysis

Duman

Bayram²,

Timur³

et al. 2023

Turk Gogus Kalp Dama

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Background: In this systematic review, we aimed to examine the risk factors and surgical outcomes of gastrointestinal complications using the meta-analysis techniques. Methods: Studies involving patients with and without gastrointestinal complications after cardiac surgery were electronically searched using the PubMed database, Cochrane Library and Scopus database, between January 2000 and May 2022. Some studies on gastrointestinal complications examined only single gastrointestinal complication (only intestinal ischemia, only gastrointestinal bleeding or only liver failure). Studies evaluating at least three different gastrointestinal complications were included in the meta-analysis to reduce the heterogeneity. Cohort series that did not compare outcomes of patients with and without gastrointestinal complications, studies conducted in a country"s health system databases, review articles, small case series (<10 patients) were excluded from the meta-analysis. Results: Twenty-five studies (8 prospective and 17 retrospective) with 116,105 patients were included in the meta-analysis. The pooled incidence of gastrointestinal complications was 2.51%. Patients with gastrointestinal complications were older (mean difference [MD]=4.88 [95% confidence interval [CI]: 2.85-6.92]; p<0.001) and had longer cardiopulmonary bypass times (MD=17.7 [95% CI: 4.81-30.5]; p=0.007). In-hospital mortality occurred in 423 of 1,640 (25.8%) patients with gastrointestinal complications. In-hospital mortality was 11.8 times higher in patients with gastrointestinal complications (odds ratio [OR]=11.8 [95% CI: 9.5-14.8]; p<0.001). Conclusion: The development of gastrointestinal complications after cardiac surgery is more commonly seen in patients with comorbidities. In-hospital mortality after cardiac surgery is 11.8 times higher in patients with gastrointestinal complications than in patients without.

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Section: No Gi Complicationsmentioning

confidence: 99%

Predictors and outcomes of gastrointestinal complications after cardiac surgery: A systematic review and meta-analysis

Duman

Bayram²,

Timur³

et al. 2023

Turk Gogus Kalp Dama

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“…[15] In a retrospective analysis that was published in 2008 that analyzed risk factors of gastrointestinal complications after cardiac surgeries, found that the decrease in blood flow and thus DO2 results in a state that the GI tract is not capable to recompense, because it doesn't have the ability of autoregulation. [16] Furthermore this state of hypoperfusion might be continued even after the re-establishment of adequate flows and pressures. A study that compared the importance of flow versus pressure during CPB in rabbits using laser Doppler flowmetry showed that the low splanchnic perfusion during CPB in mainly reliant on the pump blood flow.…”

Section: Blood Flow During Cpb: Goals and Requirementsmentioning

confidence: 99%

Advanced Perfusion Techniques - Flow versus Pressure

Pappa¹,

Theodosiadis²,

Paliouras³

et al. 2017

J. Biomed

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Cardiac operations which require Cardiopulmonary bypass (CPB) are considered the most common procedures in cardiac surgery, performed for more than half a century, especially in Europe and North America. Despite that new technologies are being incorporated in CPB as long as the development of new techniques in CPB, some debates still remain. These debates regard the achievement of the needed optimal perfusion during CPB and the relation between perfusion pressures and the optimal blood flow during extracorporeal circulation. Blood flow and blood pressure during Cardiopulmonary bypass are very important factors. Although more studies are in favor of a minor superiority of the optimal blood flow requirements, compared to the corresponding optimal blood pressure needs, their role is quite interdependent. The usage of contemporary electronic Data Management Systems (DMS) led to a significant evolution of the perfusion science. Adequate perfusion can now be judged by its results in real time, while information from DMS, such as venous saturation, levels of haemoglobin and lactate, may be used as the markers of optimal perfusion and additionally for the development of the perfusion protocols in the future.

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“…However, most of the other studies described gastrointestinal complications after cardiac surgery in general. Others compared colectomy of all causes to patients who were treated medically without surgical intervention [8, 9]. A comparison of medically treated patients with colonic complications after cardiac surgery is not eligible in our view.…”

Section: Commentmentioning

confidence: 99%

Ischemic Colitis after Cardiac Surgery: Can We Foresee the Threat?

et al. 2016

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IntroductionIschemic colitis (IC) remains a great threat after cardiac surgery with use of extracorporeal circulation. We aimed to identify predictive risk factors and influence of early catecholamine therapy for this disease.MethodsWe prospectively collected and analyzed data of 224 patients, who underwent laparotomy due to IC after initial cardiac surgery with use of extracorporeal circulation during 2002 and 2014. For further comparability 58 patients were identified, who underwent bypass surgery, aortic valve replacement or combination of both. Age ±5 years, sex, BMI ± 5, left ventricular function, peripheral arterial disease, diabetes and urgency status were used for match-pair analysis (1:1) to compare outcome and detect predictive risk factors. Highest catecholamine doses during 1 POD were compared for possible predictive potential.ResultsPatients’ baseline characteristics showed no significant differences. In-hospital mortality of the IC group with a mean age of 71 years (14% female) was significantly higher than the control group with a mean age of 70 (14% female) (67% vs. 16%, p<0.001). Despite significantly longer bypass time in the IC group (133 ± 68 vs. 101 ± 42, p = 0.003), cross-clamp time remained comparable (64 ± 33 vs. 56 ± 25 p = 0.150). The majority of the IC group suffered low-output syndrome (71% vs. 14%, p<0.001) leading to significant higher lactate values within first 24h after operation (55 ± 46 mg/dl vs. 31 ± 30 mg/dl, p = 0.002). Logistic regression revealed elevated lactate values to be significant predictor for colectomy during the postoperative course (HR 1.008, CI 95% 1.003–1.014, p = 0.003). However, Receiver Operating Characteristic Curve calculates a cut-off value for lactate of 22.5 mg/dl (sensitivity 73% and specificity 57%). Furthermore, multivariate analysis showed low-output syndrome (HR 4.301, CI 95% 2.108–8.776, p<0.001) and vasopressin therapy (HR 1.108, CI 95% 1.012–1.213, p = 0.027) significantly influencing necessity of laparotomy.ConclusionPatients who undergo laparotomy for IC after initial cardiac surgery have a substantial in-hospital mortality risk. Early postoperative catecholamine levels do not influence the development of an IC except vasopressin. Elevated lactate remains merely a vague predictive risk factor.

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Gastrointestinal Emergencies in Cardiac Surgery

Cited by 12 publications

References 29 publications

Predictors and outcomes of gastrointestinal complications after cardiac surgery: A systematic review and meta-analysis

Predictors and outcomes of gastrointestinal complications after cardiac surgery: A systematic review and meta-analysis

Advanced Perfusion Techniques - Flow versus Pressure

Ischemic Colitis after Cardiac Surgery: Can We Foresee the Threat?

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