Predicting outcomes of mesenteric ischemia postcardiac surgery: A systematic review

Abstract

Objective This systematic review aims to identify predictors of outcomes of mesenteric ischemia in patients following cardiac surgery. Methods A comprehensive literature search was done on EMBASE, PubMed, Ovid MEDLINE, and SCOPUS using keywords relating to bowel ischemia and cardiac surgery. Database search results were screened by at least two authors and 32 articles were selected for inclusion in this review. Results Data on 1907 patients were analyzed. The mean age was 70.0 ± 2.99 years and the prevalence of bowel ischemia was 1.74%. Advanced age was a significant risk factor. 63.16% of patients reported were men, and 58.4% of patients died in hospital. There was heterogeneity in the reported significance of the following preoperative risk factors: hypertension, smoking status, type 2 diabetes mellitus, end‐stage renal disease, preoperative left ventricular ejection fraction <35%. Cardiopulmonary bypass (CPB) time, preoperative/operative intra‐aortic balloon pump (IABP) support, and inotrope usage were significantly associated with the development of mesenteric ischemia; however, other intraoperative factors including the type of cardiac surgery and duration of aortic cross‐clamping had varying levels of reported significance. There were discrepancies in the reported significance of leukocytosis and metabolic acidosis (pH <7.3) as postoperative markers. Postoperative vasopressor use, prolonged ventilation time, and elevation in lactate, transaminases, creatinine, and intestinal fatty acid‐binding protein (IFABP) levels were found to be strongly associated with bowel ischemia. Conclusion This systematic review found the strongest associations of mesenteric ischemia postcardiac surgery to be advanced age, CPB time, rise in lactate, transaminases, creatinine, and IFABP. IABP support, vasopressor, and inotrope use as well as prolonged ventilation were strongly linked too.

IFABP levels predict visceral malperfusion in the first hours after open thoracoabdominal aortic repair

“…A promising biomarker strongly associated with the incidence of bowel ischemia is intestinal fatty acid-binding protein (IFABP) ( 5 ). This 15 kDa protein is expressed in the cytoplasm of mature enterocytes found at the end of the intestinal villi ( 6 ).…”

“…This area of the gut wall is the most distant from the intestinal capillary network and, as such, it bears the highest risk to be the first to succumb to malperfusion ( 7 ). Under the premise of this mechanism, many studies have investigated the clinical applicability and reliability of IFABP for the diagnosis of intestinal necrosis ( 1 , 5 , 6 ). The focus of its clinical relevance is placed on the detection of mesenteric ischemia affecting the small intestine, since the concentration of the protein is in this segment twenty times higher than in the large intestine ( 8 ).…”

Mesenteric ischemia postcardiac surgery—Elusive and less stratified complexity

“…We read with great interest the systematic review by Kayali et al 5 The authors have included 1907 patients from 32 different articles. The major preoperative risk factors for developing AMI are age, smoking status, type 2 diabetes, end‐stage renal disease, and a left ventricular function of <35%.…”