Adverse Gastrointestinal Complications After Cardiopulmonary Bypass: Can Outcome Be Predicted from Preoperative Risk Factors?

McSweeney, Mary E.; Garwood, Susan; Levin, J; Marino, Maria; Wang, Shirley X.; Kardatzke, David; Mangano, Dennis T.; Wolman, Richard L.

doi:10.1213/01.ane.0000113556.40345.2e

Cited by 56 publications

(44 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The pathophysiology of GI complications following cardiac surgery has not been well elucidated. Low cardiac output resulting in visceral hypoperfusion and mucosal ischemia and necrosis has been suggested on by multiple authors [1,9]. Multiple risk factors have been considered significant with GI complications including age greater than 70 years, long duration of cardiopulmonary bypass, blood transfusion, reoperation, ischemic heart disease, renal failure, and low cardiac index [10].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Impact of Gastrointestinal Complications on Patients who Undergo Coronary Artery Bypass Grafting

Lemaire¹

2014

J Cardiovasc Dis Diagn

View full text Add to dashboard Cite

Objective: The incidence of gastrointestinal (GI) complications in patients undergoing coronary artery bypass grafting (CABG) is increasing as the population ages. The reported incidence ranges from 0.3% to 3.7%. Coronary Artery Bypass Grafting (CABG) is one of the most common operations performed. The outcome of patients who undergo abdominal operations for GI complications after CABG is not known. The purpose of the study is to determine the impact of abdominal surgery on patients who undergo CABG. Methods:A retrospective review of nationwide data of all patients undergoing CABG from 2006 to 2010. A total of 160,513 patients who underwent CABG were reviewed.Results: A total of 236 patients out of the 160,513 patients who underwent CABG developed GI complications that required abdominal surgery. The abdominal procedures included small and large bowel resections as well as colostomy formation. The indications for abdominal surgery varied and included ischemic bowel, and bowel obstruction. The patients who underwent concomitant abdominal surgery were more likely to develop renal Confidence Interval (CI) (8.5 to 14.2) (P<0.0001), respiratory CI (8.5 to 14.8) (P<0.0001), and infectious CI (16.3 to 28.6) (P<0.0001) complications. They were also more likely to have higher mortality CI (16.2 to 29.0), (P<0.0001). Patients who underwent abdominal operations had longer length of stay (LOS) 37.23 ± 32.8 days versus 8.2 ± 6.1 days (P<0.0001) and higher hospital charges, $389,586 ± 2 60,546 compared to $111,290 ± 82,462.2 (P<0.0001). Conclusion:Although rare, the impact of abdominal surgery resulting from GI complications is significant. The patients who had abdominal surgery and underwent CABG were more likely to develop multiple complications. As a result, these patients had a higher rate of mortality, longer LOS, and higher hospital costs. Taken together, these results indicate that patients with GI complications should be identified promptly and aggressively treating these patients is of paramount importance.Citation: Lemaire A, Batsides G, Ghaly A, Solina A, Dombrovsky V, et al. (2014) The Impact of Gastrointestinal Complications on Patients who Undergo Coronary Artery Bypass Grafting. J Cardiovasc Dis Diagn 2: 153.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Gastrointestinal (GI) complications have been reported to occur after cardiac surgery 0.29% -5.5% and are associated with mortality rates of 11% -72% [1][2][3][4]. The high mortality in these patients has been attributed to delayed diagnosis and treatment of GI complications.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Gastrointestinal Complications on Patients who Undergo Coronary Artery Bypass Grafting

Lemaire¹

2014

J Cardiovasc Dis Diagn

View full text Add to dashboard Cite

show abstract

“…The transfusion of bank blood and the use of pharmacologic cardiovascular support were identified as independent intraoperative risk factors (7). Improvements in surgical techniques such as off-pump surgery do not seem to have made any significant impact on the incidence or prognosis of adverse GI outcome (8).…”

Section: Predictorsmentioning

confidence: 99%

Gastrointestinal complications and its predictors after cardiac surgery

Yapıcı¹,

İnce²

2010

Turk J Gastroenterol

View full text Add to dashboard Cite

“…Although clinical and experimental trials have showed that the splanchnic injury is in most of the cases transient and selflimiting, manifest heart insufficiency, whenever in the presence or absence of the atheromatous disease, contributes to a higher incidence of intestinal complications after CPB (11,12). Constricting (e.g., thromboxane A 2 , angiotensin II, and endothelin-1), vasodilating (e.g., nitric oxide [NO]), and inflammatory hormones (cytokines) released locally by the endothelium, nerve terminals, platelets, and leukocytes have been suggested to participate in heart failure (HF)-induced vascular remodeling (13) and, may subsequently exacerbate the post-CPB mesenteric damage.…”

Section: Introductionmentioning

confidence: 99%

Mesenteric Vascular Dysfunction After Cardiopulmonary Bypass With Cardiac Arrest Is Aggravated by Coexistent Heart Failure

Andrási

Bielik

Blázovics

et al. 2005

Shock

View full text Add to dashboard Cite

Although patients suffering from heart failure (HF) have an increased incidence of nonocclusive mesenteric ischemia after opened heart surgery, the impact of cardiopulmonary bypass with cardiac arrest (CPB) on mesenteric vascular circulation in such situation remains unexplored. Therefore, the present study investigates the effects of CPB on mesenteric vascular reactivity, regional metabolism, and oxidative stress in an experimental model of HF. Volume-overload HF was induced in six dogs by bilateral femoral arteriovenous fistula. Six sham-operated dogs were used as controls. Eight weeks later, the short-term effects of 90 min of CPB were assessed in vivo during acute experiments. The significant increase in left ventricular end-diastolic volume in HF animals did not influence the vasodilator response of the superior mesenteric artery to acetylcholine (ACH) and nitroprusside (SNP) under baseline conditions. However, reduced mesenteric oxygen delivery, increased oxygen extraction, and lactate release were found during CPB in the HF group. In addition, an increased free radical production was assessed in the HF group during (89 +/- 23 x 10 relative light units [RLU]) and after CPB (93 +/- 15 x 10 RLU) compared with controls (45 +/- 15 and 49 +/- 7 x 10 RLU, respectively). Finally, 90 min of CPB led to a more pronounced decrease of ACH- (-22% +/- 5% vs. -42% +/- 9%, P < 0.05) and SNP- (-14% +/- 4% vs. -50% +/- 7%, P < 0.002) induced mesenteric vasodilations in the HF group compared with controls. We conclude that coexistent HF significantly enhances the pathological effects of CPB on the mesenteric vascular circulation by additionally altering endothelial and smooth muscle vascular function consequent to augmented oxidative stress.

show abstract

Adverse Gastrointestinal Complications After Cardiopulmonary Bypass: Can Outcome Be Predicted from Preoperative Risk Factors?

Cited by 56 publications

References 18 publications

The Impact of Gastrointestinal Complications on Patients who Undergo Coronary Artery Bypass Grafting

The Impact of Gastrointestinal Complications on Patients who Undergo Coronary Artery Bypass Grafting

Gastrointestinal complications and its predictors after cardiac surgery

Mesenteric Vascular Dysfunction After Cardiopulmonary Bypass With Cardiac Arrest Is Aggravated by Coexistent Heart Failure

Contact Info

Product

Resources

About