Intestinal ischaemia following cardiac surgery: a multivariate risk model☆

Chaudhuri, Nilanjan; James, Justin; Sheikh, Adnan; Grayson, Antony D.; Fabri, Brian M.

doi:10.1016/j.ejcts.2006.03.014

Cited by 40 publications

(33 citation statements)

References 21 publications

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“…We found a lower incidence, 0.09%, than previously presented, but the mortality rate was comparable with others [4,10,12,18-20]. Risk factors were identified that can aid in the diagnosis.…”

Section: Discussionsupporting

confidence: 85%

“…In the present study, when investigating preoperative factors we found the use of steroids, peripheral vascular disease, cardiogenic chock, and NYHA class 4 to be independent prognostic factors for development of the complication. Peripheral vascular disease has previously been pointed out as a risk factor as well as a poor preoperative cardiac condition [5,10,12]. In one older publication, the use of steroids - but in that case postoperatively - was a factor associated with an increased risk of general surgical complications after cardiac surgery [21].…”

Section: Discussionmentioning

confidence: 99%

“…With intestinal ischemia, a delayed diagnosis and surgical intervention can be fatal [5]. Various demographic and surgical variables and postoperative events have been suggested as risk factors for GI complications [1,6-9], and also for intestinal ischemia in particular [5,10-12]. This identification is important and can lead to earlier diagnosis and treatment.…”

Section: Introductionmentioning

confidence: 99%

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Intestinal ischemia after cardiac surgery: analysis of a large registry

Nilsson

Hansson

Andersson

2013

J Cardiothorac Surg

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BackgroundIntestinal ischemia after cardiac surgery is a rare but severe complication with a high mortality. Early surgery can be lifesaving. The aim was to analyze the incidence, outcome, and risk factors for these patients.MethodsA prospectively collected database with patients who underwent 18,879 cardiac surgical procedures between 1996 and 2011 was investigated. All patients with registered gastrointestinal complications were retrospectively reviewed. Univariate and multivariate analyses were performed to compare patients with and without intestinal ischemia.ResultsSeventeen patients suffered from intestinal ischemia (0.09%), 10 of whom (59%) died. By investigating preoperative parameters independent risk factors were steroids, peripheral vascular disease, cardiogenic shock, and New York Heart Association class 4. When including pre-, per-, and postoperative parameters, only postoperative ones were significant, including elevated creatinine (> 200 μmol/L), prolonged ventilator time, need for intra-aortic balloon pump, and cerebrovascular insult (CVI). The gastrointestinal complications score (GICS) showed a ROC area of 0.87. This was superior compared with EuroSCORE (0.74), to predict intestinal ischemia.ConclusionsIntestinal ischemia after cardiac surgery is more common in patients with a poor cardiac state, but the use of steroids, peripheral vascular disease, postoperative kidney failure, and CVI were also predictive. GICS score, developed for all GI complications after cardiac surgery, is also of value in predicting this particular complication. The risk factors presented can be used as an aid in the diagnosis of these patients.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intestinal ischemia after cardiac surgery: analysis of a large registry

Nilsson

Hansson

Andersson

2013

J Cardiothorac Surg

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“…The effect of preoperative A Fib on gastrointestinal complications is a direct result of both low output state and embolic nature of such cases. These can lead to bowel ischemic or unstable gastrointestinal haemorrhages from low perfusion state [9]. Data on short-term mortality in A Fib patients are rather conflicting (Table 5).…”

Section: Discussionmentioning

confidence: 99%

Effect of Preoperative Atrial Fibrillation on Postoperative Outcome following Cardiac Surgery

Al-Sarraf

Thalib

Hughes

et al. 2012

Cardiology Research and Practice

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Atrial fibrillation remains the commonest arrhythmia encountered in cardiac surgery. Data on the effect of preoperative atrial fibrillation on postoperative outcome remain limited. We sought to assess the effects preoperative atrial fibrillation on patients' outcome following cardiac surgery. This is a retrospective review of prospectively collected departmental data of all patients who underwent cardiac surgery over 8-year period. Our cohort consisted of 3777 consecutive patients divided into atrial fibrillation (n = 413, 11%) and sinus rhythm (n = 3364, 89%). Postoperative complications and in-hospital mortality were analysed. Univariate analysis showed significantly increased mortality and major complications in atrial fibrillation compared to sinus rhythm patients. Using multiple logistic regression analysis and after accounting for Euro SCORE as a confounding variable, we found that preoperative atrial fibrillation significantly increases the risk of mortality (OR 1.7), low cardiac output state (OR 1.3), prolonged ventilation (OR 1.4), infective complication (OR 1.5), gastrointestinal complications (OR 2.0), and intensive care unit readmission (OR 1.6). Preoperative atrial fibrillation in cardiac surgery patients increases their risk of mortality and major complications following cardiac surgery. Surgical strategies such as Cox-Maze procedure may be beneficial in these patients.

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“…Besides the heart, the intestine is also commonly affected by I/R injury, which can be due to, for example, cardiac arrest (6), hemorrhagic shock (7), burn trauma (8) or vascular and cardiac surgery (9)(10)(11). Animal studies and clinical observations revealed that ischemia leads to increased permeability of the intestinal epithelial barrier, resulting in translocation of pathogenic bacteria and endotox- ins (12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

Serum from Patients Undergoing Remote Ischemic Preconditioning Protects Cultured Human Intestinal Cells from Hypoxia-Induced Damage: Involvement of Matrixmetalloproteinase-2 and -9

Zitta

Meybohm

Bein

et al. 2011

Mol Med

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Remote ischemic preconditioning (RIPC) can be induced by transient occlusion of blood flow to a limb with a blood pressure cuff and exerts multiorgan protection from ischemia/reperfusion injury. Ischemia/reperfusion injury in the intestinal tract leads to intestinal barrier dysfunction and can result in multiple organ failure. Here we used an intestinal cell line (CaCo-2) to evaluate the effects of RIPC-conditioned patient sera on hypoxia-induced cell damage in vitro and to identify serum factors that mediate RIPC effects. Patient sera (n = 10) derived before RIPC (T0), directly after RIPC (T1) and 1 h after RIPC (T2) were added to the culture medium at the onset of hypoxia until 48 h after hypoxia. Reverse transcription-polymerase chain reaction, lactate dehydrogenase (LDH) assays, caspase-3/7 assays, silver staining, gelatin zymography and Western blotting were performed. Hypoxia led to morphological signs of cell damage and increased the release of LDH in cultures containing sera T0 (P < 0.01) and T1 (P < 0.05), but not sera T2, which reduced the hypoxia-mediated LDH release compared with sera T0 (P < 0.05). Gelatin zymography revealed a significant reduction of activities of the matrixmetalloproteinase (MMP)-2 and MMP-9 in the protective sera T2 compared with the nonprotective sera T0 (MMP-2: P < 0.01; MMP-9: P < 0.05). Addition of human recombinant MMP-2 and MMP-9 to MMP-deficient culture media increased the sensitivity of CaCo-2 cells to hypoxia-induced cell damage (P < 0.05), but did not result in a reduced phosphorylation of prosurvival kinases p42/44 and protein kinase B (Akt) or increased activity of caspase-3/7. Our results suggest MMP-2 and MMP-9 as currently unknown humoral factors that may be involved in RIPC-mediated cytoprotection in the intestine.

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Intestinal ischaemia following cardiac surgery: a multivariate risk model☆

Cited by 40 publications

References 21 publications

Intestinal ischemia after cardiac surgery: analysis of a large registry

Intestinal ischemia after cardiac surgery: analysis of a large registry

Effect of Preoperative Atrial Fibrillation on Postoperative Outcome following Cardiac Surgery

Serum from Patients Undergoing Remote Ischemic Preconditioning Protects Cultured Human Intestinal Cells from Hypoxia-Induced Damage: Involvement of Matrixmetalloproteinase-2 and -9

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