Colectomy after heart surgery with use of extracorporeal circulation

R Arif; M Zaradzki; C Reissfelder; P Seppelt; M Verch; S Schwill; A Ruhparwar; M Karck; K Kallenbach

doi:10.1055/s-0032-1332331

The Thoracic and Cardiovascular Surgeon, Table of Contents

Colectomy after heart surgery with use of extracorporeal circulation

R Arif ¹, M Zaradzki ¹, C Reissfelder ², P Seppelt ¹, M Verch ³, S Schwill ¹, A Ruhparwar ¹, M Karck ¹, K Kallenbach ³

¹University of Heidelberg, Heart Surgery, Heidelberg, Germany
²University of Heidelberg, Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Germany
³University of Heidelberg, Heidelberg, Germany

Abstract

Objectives: Gastrointestinal complications after heart surgery with help of extracorporeal circulation (ECC) can lead to necessity of colectomy due to obstructive and non-obstructive disease of the large intestine. We aimed to identify factors influencing occurrence and outcome of this complication.

Methods: We identified 83 patients (average age 68 years; 64 male (77%) out of 11.955 after cardiovascular surgery with help of ECC who underwent colectomy in our department between July 2002 and March 2012. Preoperative, intraoperative and postoperative data were analysed. We statistically compared in-hospital mortality with hospital survivors.

Results: Histopathological and morphological diagnoses revealed 3 cases of occlusive ischemic colitis. 80 patients were diagnosed with non-occlusive disease including ischemic colitis and Ogilvie syndrome.

49 patients (59%) died within hospital stay of which 86% (p = 0.025) were male. They had to sustain significantly longer intraoperative cardiac arrest (p < 0.001) and received higher dose of noradrenaline (p = 0.013) and adrenaline (p = 0.01) on 1^st postoperative day (POD). Deceased patients underwent more subtotal colectomy (p = 0.013) and had more need of postoperative dialysis (p < 0.001). Survivors were operated significantly more often within the first 7 POD (p = 0.034) after initial operation. Surprisingly, neither lactate value of the 1^st POD (p = 0.811), nor emergency status (p = 0.203), cardiopulmonary bypass (p = 0.667) or cross-clamp time (p = 0.324) did significantly influence survival.

Conclusion: Early reduction of vaso-constrictive catecholamine therapy and prompt diagnosis and surgical therapy of ischemic colitis, Ogilvie syndrome or occlusive large intestine disease can improve survival of these life-threatening complications after cardiovascular operation with help of ECC.