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 21 February 2018

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Gastrointestinal complications in patients with heart operations

The most common gastrointestinal complication after cardiac surgery is mesenteric ischemia, which is frequently fatal as a result of atheroembolization, heparin-induced thrombocytopenia, or hypoperfusion reports the latest issue of Annals of Surgery.

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Gastrointestinal complications following heart operation may be life-threatening.

Dr Mangi and colleagues conducted a systematic analysis of risk factors to allow early identification of patients at risk for gastrointestinal complications.

The researchers would like the information to lead to the development of strategies to mitigate this complication as well as to optimize management after its occurrence.

The research team included 8709 consecutive patients undergoing heart operation during 7 years from 1997 to 2003.

Mortality rate with mesenteric ischemia is 40% higher than in groups of other diagnoses
Annals of Surgery

The team reported that 46 patients developed gastrointestinal complications requiring surgical consultation.

The researchers identified preoperative, intraoperative, and postoperative predictors of complication and death, and compared these with a control group.

The team found that significant preoperative predictors of complication included prior cerebrovascular accident, chronic obstructive pulmonary disease, renal insufficiency and hypertension.

The investigative team found that type II heparin-induced thrombocytopenia, atrial fibrillation, prior myocardial infarction, and the need for intra-aortic balloon counter-pulsation were also predictors of complications.

The most frequent serious gastrointestinal complication was mesenteric ischemia, which developed in 31 patients.

The researchers explored 22 of these patients, and found that 14 died within 2 days of heart operation.

Of the 9 patients with mesenteric ischemia who the team did not explore, 7 died within 3 days of heart operation.

The research team noted that other complications included diverticulitis in 5 patients, pancreatitis in 4, peptic ulcer disease in 4, and cholecystitis in 2.

The mortality rate in this group of other diagnoses was 40% lower, and death occurred later at 32 days after heart operation, compared with mesenteric ischemia.

The team observed that predictors of death from gastrointestinal complication included New York Heart Association class III and IV heart failure, smoking, and history of syncope.

Other predictors of death were chronic obstructive pulmonary disease, aspartate aminotransferase more than 600U/L, direct bilirubin more than 2.4mg/dL, a pH less than 7, and the need for more than 2 pressors.

Dr Mangi's team concludes, “The most common catastrophic gastrointestinal complication after cardiac surgery is mesenteric ischemia, which is frequently fatal.”

“This complication may be a result of atheroembolization, heparin-induced thrombocytopenia, or hypoperfusion.”

“Techniques to reduce the occurrence of and/or preemptively diagnosis postcardiotomy mesenteric ischemia are necessary to decrease its associated mortality.”

Ann Surg 2005: 241(6): 895
26 May 2005

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