Gastrointestinal Complications after Mitral Valve Surgery

Abstract

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.

Gastrointestinal Complications after Cardiac Surgery: Incidence, Predictors, and Impact on Outcomes

“…The incidence of GI complications in our cohort was 2.4%, which is comparable to prior series, in which the occurrence of GI complications ranged from 0.5 to 4.5% [2][3][4][5][6] . Several risk factors such as advanced age, chronic obstructive pulmonary disease, heart failure, and worsening preoperative renal function, were identified to be associated with increased risk for development of GI complications.…”

“…Gastrointestinal (GI) complications are an uncommon, but potentially highly morbid events following cardiac surgery procedures 1 . The reported incidence of these events are between 0.5%-4.5% of cardiac cases, but the in-hospital mortality associated with GI complications is around 30%-40%, with some series reporting higher rates of mortality [2][3][4][5][6][7][8] . Previous series have identified several risk factors such as increasing age and comorbidity, as well as and prolonged operation times as risk factors for development of GI complications 3,4,7 .…”

Gastrointestinal complications after cardiac surgery: Incidence, predictors, and impact on outcomes

“…Several risk factors such as advanced age, chronic obstructive pulmonary disease, heart failure, and worsening preoperative renal function, were identified to be associated with increased risk for the development of GI complications. While these risk‐factors typically portend worse prognoses in cardiac surgical patients due to their affiliation with a declining preoperative clinical status, they also serve as surrogates for important physiological events that proceed GI complications as well as concomitant non‐GI complications 2,3,9,10 . For instance, elderly patients and those with the chronic obstructive pulmonary disease from smoking may have a higher vascular calcific burden placing them at risk of gastrointestinal ischemia from ischemic events.…”

Evolução pós-operatória mediata e tardia de pacientes submetidos a cirurgias cardíacas eletivas

“…Encontramos diversos estudos investigando as principais complicações dos pacientes no perioperatório de cirurgias cardíacas, porém, a maioria dos estudos investigou a ocorrência das complicações durante a permanência do paciente na Unidade de Terapia Intensiva (UTI) (CAMPAGNUCCI et al, 2008;CSERÉP et al, 2014;FONSECA et al, 2014;GUARAGNA et al, 2004;LAIZO et al, 2010;NOZAWA et al, 2003;SOARES et al, 2011). Poucos investigaram a ocorrência das complicações no PO mediato, ou seja, o período que compreende a alta da UTI até a alta da enfermaria (BECCARIA et al, 2015;GULKAROV et al, 2014;LEDUR et al, 2012;RODRIGUES et al, 2009); assim como no PO tardio (CACERES et al, 2013;MEDORIMA, 2017).…”

“…Encontramos na literatura, até o momento, quatro pesquisas que investigaram a presença de complicações e mortalidade no PO mediato de cirurgias cardíacas (BECCARIA et al, 2015;GULKAROV et al, 2014;LEDUR et al, 2012;RODRIGUES et al, 2009), e dois estudos que acompanharam a longo prazo os pacientes submetidos às cirurgias cardíacas (CACERES et al, 2013;MEDORIMA, 2017). No item "Desfecho da internação", foi sugerido por um dos juízes a inclusão da variável "data da alta" para calcular o tempo de internação hospitalar, sugestão acatada pelos pesquisadores.…”