Risk factors for nonocclusive mesenteric ischemia after elective cardiac surgery

Groesdonk, Heinrich V.; Klingele, Matthias; Schlempp, Sandra; Bomberg, Hagen; Schmied, Wolfram; Minko, Peter; Schäfers, Hans‐Joachim

doi:10.1016/j.jtcvs.2012.11.022

Cited by 84 publications

(84 citation statements)

References 25 publications

(43 reference statements)

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“…It has already been reported that cardiac surgeries increase intestinal permeability leading to gut ischemia resulting in the translocation of microorganisms and endotoxins into the systemic circulation through the portal and lymphatic systems [58], leading to a continuing toxic insult and systemic tissue injury. In addition, surgical trauma itself contributes to the complex inflammatory response that occurs after cardiac procedures [59]. Metformin treatment was given only for two coronary artery disease (CAD) patients.…”

Section: Discussionmentioning

confidence: 99%

Elevated Levels of Circulating DNA in Cardiovascular Disease Patients: Metagenomic Profiling of Microbiome in the Circulation

et al. 2014

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Cardiovascular diseases (CVDs) are the leading cause of death worldwide. An expanding body of evidence supports the role of human microbiome in the establishment of CVDs and, this has gained much attention recently. This work was aimed to study the circulating human microbiome in CVD patients and healthy subjects. The levels of circulating cell free DNA (circDNA) was higher in CVD patients (n = 80) than in healthy controls (n = 40). More specifically, the relative levels of circulating bacterial DNA and the ratio of 16S rRNA/β-globin gene copy numbers were higher in the circulation of CVD patients than healthy individuals. In addition, we found a higher circulating microbial diversity in CVD patients (n = 3) in comparison to healthy individuals (n = 3) by deep shotgun sequencing. At the phylum level, we observed a dominance of Actinobacteria in CVD patients, followed by Proteobacteria, in contrast to that in healthy controls, where Proteobacteria was predominantly enriched, followed by Actinobacteria. The circulating virome in CVD patients was enriched with bacteriophages with a preponderance of Propionibacterium phages, followed by Pseudomonas phages and Rhizobium phages in contrast to that in healthy individuals, where a relatively greater abundance of eukaryotic viruses dominated by Lymphocystis virus (LCV) and Torque Teno viruses (TTV) was observed. Thus, the release of bacterial and viral DNA elements in the circulation could play a major role leading to elevated circDNA levels in CVD patients. The increased circDNA levels could be either the cause or consequence of CVD incidence, which needs to be explored further.

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Section: Discussionmentioning

confidence: 99%

Elevated Levels of Circulating DNA in Cardiovascular Disease Patients: Metagenomic Profiling of Microbiome in the Circulation

et al. 2014

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“…Extracorporeal circulation leads to a systemic inflammatory response syndrome with hemodynamic changes most commonly involving vasodilation and the need for vasopressor treatment [1,15]. Several studies have documented alterations in gastric microcirculation during extracorporeal circulation [5,6].…”

Section: Discussionmentioning

confidence: 99%

Vasopressin Aggravates Cardiopulmonary Bypass-Induced Gastric Mucosal Ischemia

Bomberg

Bierbach²,

Flache³

et al. 2014

Eur Surg Res

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Background/Aim: Upper gastrointestinal bleeding (UGIB) is one of the most frequent gastrointestinal complications after cardiac surgery with cardiopulmonary bypass (CPB). Endothelin expression and microcirculatory dysfunction have been shown to be involved in UGIB. The aim of this study was to analyze the effect of vasopressin during CPB on the gastric mucosal microcirculation and the involvement of the endothelin system. Methods: Eighteen pigs were randomized into three groups (n = 6 each): group I = sham, group II = CPB (1-hour CPB) and group III = CPB + vasopressin (1-hour CPB and vasopressin administration during CPB to maintain baseline arterial pressure). All animals were observed for a further 90 min after termination of CPB. Systemic hemodynamics as well as blood flow and oxygen saturation of the gastric mucosa were measured continuously. At the end of the experiment, the gastric mucosal expressions of endothelin-1 (ET-1) and its receptor subtypes A (ET_A) and B (ET_B) were determined by polymerase chain reaction. Gastric mucosal injury, apoptotic cell death and leukocytic infiltration were determined by histology and immunohistochemical analyses of cleaved caspase-3 and myeloperoxidase. Results: CPB decreased gastric microvascular perfusion, which was associated with an increased expression of ET-1 and ET_A. Vasopressin aggravated the CPB-associated malperfusion, whereas it completely abrogated the upregulation of ET-1 and ET_A. Interestingly, vasopressin did not induce gastric mucosal morphologic injury, leukocytic infiltration or apoptotic cell death. Conclusion: Vasopressin aggravates CPB-associated microvascular malperfusion of the gastric mucosa but does not induce gastric mucosal injury.

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“…Recent studies demonstrated the frequent occurrence of nonocclusive mesenteric ischaemia after cardiac and vascular surgery [8][9][10][11] and also in chronic hemodialysis patients [12]. According to these studies, risk factors for the occurrence of a NOMI in cardiovascular patients are increased serum lactate levels > 5 mmmol/L, the application of an intra-aortal balloon pump, and the need for hemodialysis [13]. Additionally, for dialysis patients, the duration of their dialysis and comorbid diabetes mellitus are additional risk factors [12,14].…”

Section: Introductionmentioning

confidence: 99%

Non-occlusive mesenteric ischaemia: The prevalent cause of gastrointestinal infarction in patients with severe burn injuries

Muschitz

Fochtmann

Keck

et al. 2015

Injury

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Risk factors for nonocclusive mesenteric ischemia after elective cardiac surgery

Abstract: A high index of suspicion for NOMI in patients with the above-mentioned risk factors may decrease the diagnostic and therapeutic delay. To identify at-risk patients the developed risk equation is a useful tool with a high specificity.

Cited by 84 publications

References 25 publications

Elevated Levels of Circulating DNA in Cardiovascular Disease Patients: Metagenomic Profiling of Microbiome in the Circulation

Elevated Levels of Circulating DNA in Cardiovascular Disease Patients: Metagenomic Profiling of Microbiome in the Circulation

Vasopressin Aggravates Cardiopulmonary Bypass-Induced Gastric Mucosal Ischemia

Non-occlusive mesenteric ischaemia: The prevalent cause of gastrointestinal infarction in patients with severe burn injuries

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