Gastrointestinal complications after cardiac surgery

Andersson, Bodil; Nilsson, Johan; Brandt, Johan; Höglund, Peter; Andersson, Roland

doi:10.1002/bjs.4823

Cited by 85 publications

(75 citation statements)

References 25 publications

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“…[1][2][3][4][5][6][7][8] In our study, the incidence of GI complications in patients undergoing mitral valve surgery was 2.3% with a 30-day mortality of 39%, both of which consistent with existing reports. Valvular surgery was suggested to correlate with higher incidence of GI complications both by univariate [9][10][11][12][13] and multivariate 3,14) analysis, and our incidence is in agreement with this observation.…”

Section: Discussionsupporting

confidence: 90%

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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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Section: Discussionsupporting

confidence: 90%

“…However, mortality in these patients is high, ranging from 11%-70% in various studies. [1][2][3][4][5][6][7][8] Multiple published reports have examined GI complications after cardiac surgery in general. This represents a heterogeneous group of pathologies.…”

Section: Introductionmentioning

confidence: 99%

Gastrointestinal Complications after Mitral Valve Surgery

Gulkarov

Trocciola

Yokoyama

et al. 2014

Ann Thorac Cardiovasc Surg

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“…A recent international cohort study showed that preexisting liver disease, need for RRT, and higher organ failure scores were independent predictors of GI bleeding risk [533]. A multicenter prospective cohort study found the incidence of clinically important GI bleeding to be 2.6% (95% CI 1.6-3.6%) in critically ill patients [533]; however, other observational studies showed lower rates of GI bleeding [534][535][536][537].…”

Section: S Stress Ulcer Prophylaxismentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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Objective: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". Design:A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. Methods:The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable.

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“…Incidence and frequency Abdominal complications after CPB for cardiac surgery are seen in < 1% of patients [124][125][126][127][128][129][130][131][132] but carry a high mortality of 14.1% [131] . AMI represents 10%-67% of these complications [129,133,134] , and is the most lethal, with a case-fatality rate of 70% to 100% [129,131,132,135,136] .…”

Section: Ami After Cpbmentioning

confidence: 99%

Acute mesenteric ischemia after cardio-pulmonary bypass surgery

Abboud¹,

Daher²,

Boujaoude³

2008

WJG

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Acute mesenteric ischemia (AMI) is a highly-lethal surgical emergency. Several pathophysiologic events (arterial obstruction, venous thrombosis and diffuse vasospasm) lead to a sudden decrease in mesenteric blood flow. Ischemia/reperfusion syndrome of the intestine is responsible for systemic abnormalities, leading to multi-organ failure and death. Early diagnosis is difficult because the clinical presentation is subtle, and the biological and radiological diagnostic tools lack sensitivity and specificity. Therapeutic options vary from conservative resuscitation, medical treatment, endovascular techniques and surgical resection and revascularization. A high index of suspicion is required for diagnosis, and prompt treatment is the only hope of reducing the mortality rate. Studies are in progress to provide more accurate diagnostic tools for early diagnosis. AMI can complicate the post-operative course of patients following cardio-pulmonary bypass (CPB). Several factors contribute to the systemic hypo-perfusion state, which is the most frequent pathophysiologic event. In this particular setting, the clinical presentation of AMI can be misleading, while the laboratory and radiological diagnostic tests often produce inconclusive results. The management strategies are controversial, but early treatment is critical for saving lives. Based on the experience of our team, we consider prompt exploratory laparotomy, irrespective of the results of the diagnostic tests, is the only way to provide objective assessment and adequate treatment, leading to dramatic reduction in the mortality rate.

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Gastrointestinal complications after cardiac surgery

Abstract: Nine risk factors for the development of major gastrointestinal complications after cardiac surgery were identified. Gastrointestinal complications were often lethal but did not independently predict death within 30 days.

Cited by 85 publications

References 25 publications

Gastrointestinal Complications after Mitral Valve Surgery

Gastrointestinal Complications after Mitral Valve Surgery

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Acute mesenteric ischemia after cardio-pulmonary bypass surgery

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