Mesenteric Ischemia after Cardiac Surgery

Asen Petrov; Ali Taghizadeh-Waghefi; Fabio Hotz; Christian Georgi; Klaus Ehrhard Matschke; Albert Busch; Manuel Wilbring

doi:10.1055/s-0044-1786183

The Thoracic and Cardiovascular Surgeon, Table of Contents

Thorac Cardiovasc Surg 2024; 72(07): 498-509
DOI: 10.1055/s-0044-1786183

Original Cardiovascular

Mesenteric Ischemia after Cardiac Surgery

Authors

Asen Petrov

¹Department of Cardiac Surgery, University Heart Center Dresden, Medical Faculty Carl Gustav Carus of the Technical University of Dresden, Technische Universität Dresden, Dresden, Sachsen, Germany
Ali Taghizadeh-Waghefi

¹Department of Cardiac Surgery, University Heart Center Dresden, Medical Faculty Carl Gustav Carus of the Technical University of Dresden, Technische Universität Dresden, Dresden, Sachsen, Germany
Fabio Hotz

¹Department of Cardiac Surgery, University Heart Center Dresden, Medical Faculty Carl Gustav Carus of the Technical University of Dresden, Technische Universität Dresden, Dresden, Sachsen, Germany
Christian Georgi

¹Department of Cardiac Surgery, University Heart Center Dresden, Medical Faculty Carl Gustav Carus of the Technical University of Dresden, Technische Universität Dresden, Dresden, Sachsen, Germany
Klaus Ehrhard Matschke

¹Department of Cardiac Surgery, University Heart Center Dresden, Medical Faculty Carl Gustav Carus of the Technical University of Dresden, Technische Universität Dresden, Dresden, Sachsen, Germany
Albert Busch

²Division of Vascular and Endovascular Surgery, Department for Visceral-, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, Dresden, Sachsen, Germany
Manuel Wilbring

¹Department of Cardiac Surgery, University Heart Center Dresden, Medical Faculty Carl Gustav Carus of the Technical University of Dresden, Technische Universität Dresden, Dresden, Sachsen, Germany

Abstract

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Abstract

Background Mesenteric ischemia (Me-Is) after cardiac surgery is underreported in present literature but has still earned the bad reputation of a dismal prognosis. This study adds clinical outcomes in a large patient cohort.

Methods Between 2009 and 2019 of the 22,590 patients undergoing cardiac surgery at our facility 106 (0.47%) developed Me-Is postoperatively. Retrospective patient data was analyzed. Additionally, patients were stratified by outcome—survivors and nonsurvivors.

Results Patients were predominantly male (n = 68, 64.2%), mean age was 71.2 ± 9.3 years. Most procedures were elective (n = 85, 80.2%) and comprised of more complex combined procedures (50.9%) and redos (17.9%). Mean EuroSCORE II averaged 10.9 ± 12.2%. Survival at 30 days was 49.1% (n = 52). Clinical baseline and procedural characteristics did not differ significantly between survivors and nonsurvivors. The median postoperative interval until symptom onset was 5 days in both groups. Survivors were more frequently diagnosed by computed tomography and nonsurvivors based on clinical symptoms. Me-Is was predominantly nonocclusive (n = 84, 79.2%). Laparotomy was the main treatment in both groups (n = 45, 78.8% vs. n = 48, 88.9%, p = 0.94). Predictors of mortality were maximum norepinephrine doses (hazard ratio [HR] 8.29, confidence interval [CI] 3.39–20.26, p < 0.0001), lactate levels (HR 1.06, CI 1.03–1.09), and usage of inotropes (HR 2.46, CI 1.41–4.30).

Conclusion The prognosis of Me-Is following cardiac surgery is poor—independently from diagnostic or treatment patterns. There exists a significant asymptomatic time period postoperatively, in which pathophysiologic processes seem to cross the Rubicon. After clinical demarcation, the further course can almost no longer be influenced.

Keywords

liver - abdominal organs - outcomes (includes mortality morbidity) - postoperative care - surgery - complications - intensive care - cardiac

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