Lethal mesenteric ischaemia after cardiopulmonary bypass: a common complication?

Abstract

The incidence of acute mesenteric ischaemia is 0.49% of all cases undergoing CPB. A.M.Isc. is a common association with death following CPB (11%). It appears to be significantly associated with the presence of peripheral vascular disease, IABP use, the development of post-operative renal failure, operation type and priority, smoking, duration of CPB and cross-clamp time. Surprisingly, it was not linked to general risk factors for vascular disease.

Predictors of survival in patients requiring IABP support following cardiac surgery

“…Moreover, the outcome was better in patients who received IABP after CABG than after valve operation. This result is also reported in other studies (Baskett et al, 2002;Ota et al, 1992 (Andersson et al, 1993;Corwin et al, 1989;Gaudino et al, 2005;Khilji et al, 2004;Zanardo et al, 1994 (Ghosh et al, 2002;Venkateswaran et al, 2002 (Kaleya et al, 1992;Klotz et al, 2001). …”

Visceral Arterial Compromise During Intra-Aortic Balloon Counterpulsation Therapy

“…In an autopsy study on cardiac surgery patients, however, IABP use was a significant risk factor for the development of lethal mesenteric ischemia. 22,23 The high rate of laparotomy and bowel resection for mesenteric ischemia found in our study, as well as preliminary experimental flow measurements, suggests that balloon malposition is causally related to visceral malperfusion. Beside diastolic hypoperfusion, atherosclerotic embolic debris caused by mechanical interaction between the balloon and the aortic wall may be related to visceral ischemia.…”

Acute mesenteric ischemia after cardio-pulmonary bypass surgery

“…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] .…”

“…It has been observed that there is significant mesenteric hypoperfusion followed by hyperemic response [147] after off-pump cardiac surgery along with an increase in the resistive and pulsatility indexes [148] . Moreover, studies focusing on the identification of predisposing factors for mesenteric ischemia after CPB [135,[124][125][126] , have produced different, and even opposite results. Rare cases of embolic acute arterial infarction can be prevented when a calcified aorta is detected on pre-operative CT scan [149] .…”