Intraabdominal complications after cardiopulmonary bypass

Ohri, Sunil K.; Desai, JB; Gaer, Jullien; Roussak, J B; Hashemi, Masoud; Smith, Peter; Taylor, KM

doi:10.1016/0003-4975(91)91219-l

Cited by 120 publications

(59 citation statements)

References 24 publications

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“…Low flow state often requires placement of IABP which has been identified as a determining factor for abdominal complications in both multivariate 7,14,17) and univariate studies. 2,3,6,8,10,13,20) In our analysis, although postoperative IABP use was significantly more common in the GI complications group by univariate analysis ( Table 1), its impact after logistical regression analysis was not significant.…”

Section: Discussionmentioning

confidence: 57%

“…Concomitant CABG in addition to mitral valve surgery was also reported to be predictive of GI complications by multivariate analysis by Mohavedi and his coauthors, 14) who explained this correlation by longer bypass time The relationship between chronic renal failure (CRF), acute renal failure (ARF) and GI complications after cardiac surgery has been studied in several univariate 20,21) and multivariate 3,14) analysis publications. In our experience CRF is an independent determinant for GI complications.…”

Section: Discussionmentioning

confidence: 99%

“…6,8,10,20) Valve surgery that requires anticoagulation often increases bleeding. In our series, surgical intervention was not required for isolated GI bleeding; surgery was required only when there was an additional GI complication (ischemic bowel or acute cholecystitis).…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

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Gastrointestinal Complications after Mitral Valve Surgery

Gulkarov

Trocciola

Yokoyama

et al. 2014

Ann Thorac Cardiovasc Surg

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“…Hypovolemia may result in decreased perfusion of the splanchnic region [2], and at times lead to an increased incidence of postoperative complications [3]. Peptic ulceration, intestinal ischaemia and sepsis have all been reported [4][5][6][7], and in patients undergoing operations under cardiopulmonary bypass, local hypoperfusion of the splanchnic region has been found to result in decreased oxygen extraction and to an increase in serum lactate levels [8][9][10]. Induction of general anaesthesia will further augment this redistribution of circulating volume [11].…”

mentioning

confidence: 99%

The effect of a pre‐operative infusion of Ringer's solution on splanchnic perfusion in patients undergoing coronary artery bypass grafting

Klein¹,

Osmer

Müller

et al. 2002

Anaesthesia

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SummarySurgical patients develop a fluid deficit during pre-operative starvation. This study examines the effects of pre-operative fluid administration on haemodynamic variables, oxygenation and splanchnic perfusion in patients undergoing elective coronary artery bypass grafting. Forty-eight patients were randomised to receive either a pre-operative crystalloid infusion (crystalloid group, n ¼ 24) or no infusion (control group, n ¼ 24). Patients in the crystalloid group received a continuous infusion of Ringer's solution at 1.5 ml.kg )1 .h )1 from 22:00 h until induction of anaesthesia the next morning. Immediately before induction of anaesthesia, all patients were given a colloid infusion to increase pulmonary capillary wedge pressure and central venous pressure to similar levels in both groups. Haemodynamic and oxygenation parameters were measured using invasive cardiovascular monitoring, and splanchnic perfusion was assessed by indocyanine green clearance. Patients in the crystalloid group received a mean (SD) of 1008 (140) ml of Ringer's solution overnight. Patients in the crystalloid group had a higher splanchnic blood flow than the control group before induction of anaesthesia [mean (SD) ¼ 1782 (573) ml.min )1 vs. 1391 (333) ml.min )1 , p < 0.05]. There were no significant differences in systemic haemodynamic data and global oxygenation parameters between the two groups. Pre-operative infusion of crystalloid appears to result in an improvement in pre-operative splanchnic perfusion.

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“…14,15) Some investigators have suggested that a low postoperative cardiac output state gives rise to splanchnic hypoperfusion and mucosal ischemia which results in the translocation of endotoxins from the intestine into the circulation. [16][17][18] Recently, Christenson, et al 19) showed that hypertension was one of the independent risk factors for adult respiratory distress syndrome, characterized by high permeability pulmonary edema caused by endothelial damage. Patients with chronic hypertension are liable to develop hypoperfusion during CABG under ordinary pressure control.…”

Section: Discussionmentioning

confidence: 99%

Predictive Risk Factors for Pulmonary Oxygen Transfer in Patients Undergoing Coronary Artery Bypass Grafting.

et al. 2001

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SUMMARYThe ratio of arterial oxygen tension to inspired oxygen fraction (PaO 2 / FiO 2 ) is a useful indicator for weaning patients from mechanical ventilation and a reliable predictor of pulmonary dysfunction after cardiac surgery. The aim of this study was to elucidate the patient characteristics and variables that affect the PaO 2 / FiO 2 ratio.Between 1994-1998, 167 patients who underwent coronary artery bypass grafting (CABG) were examined retrospectively. Spearman's correlation coefficients were calculated between the PaO 2 / FiO 2 ratio and intubation period, and length of ICU stay. Patients were then divided into two groups with a PaO 2 / FiO 2 ratio < 350 and PaO 2 / FiO 2 ratio ≥ 350. Univariate analysis of the putative risk factors was performed. A logistic regression model was developed to evaluate factors that would influence the PaO 2 / FiO 2 ratio.A significant correlation was observed between the PaO 2 / FiO 2 ratio and intubation period, and length of ICU stay. Univariate predictors of a PaO 2 / FiO 2 ratio < 350 were low body weight, low preoperative PaO 2 , long operation time, high FiO 2 , low postoperative PaO 2 , history of smoking, hypertension and opening of pleura (p < 0.05). Excellent prediction was found with a model consisting of preoperative PaO 2 and hypertension.Conclusion: The results of this study suggest that patients with a low preoperative PaO 2 or hypertension may need more careful peri-and postoperative management since these factors are closely associated with the PaO 2 / FiO 2 ratio. (Jpn Heart J 2001; 42: 143-153)

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Intraabdominal complications after cardiopulmonary bypass

Cited by 120 publications

References 24 publications

Gastrointestinal Complications after Mitral Valve Surgery

Gastrointestinal Complications after Mitral Valve Surgery

The effect of a pre‐operative infusion of Ringer's solution on splanchnic perfusion in patients undergoing coronary artery bypass grafting

Predictive Risk Factors for Pulmonary Oxygen Transfer in Patients Undergoing Coronary Artery Bypass Grafting.

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