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Published on: October 20, 2023
Mesenteric Ischemia after Cardiac Surgery
Asen Petrov1, Ali Taghizadeh-Waghefi1, Fabio Hotz1
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.
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.
Insights
Mesenteric ischemia (Me-Is) following cardiac surgery has a poor prognosis, with survival rates around 49%. Early diagnosis and treatment do not significantly alter outcomes, highlighting the critical nature of this complication.
Area of Science:
- Cardiology
- Gastroenterology
- Surgical Outcomes
Background:
- Mesenteric ischemia (Me-Is) post-cardiac surgery is rare but associated with high mortality.
- This study investigates clinical outcomes in a large patient cohort to better understand Me-Is.
- Existing literature underreports Me-Is, despite its poor prognosis.
Purpose of the Study:
- To analyze clinical outcomes and identify mortality predictors in patients who develop Me-Is after cardiac surgery.
- To evaluate the impact of diagnostic and treatment strategies on Me-Is prognosis.
- To understand the temporal relationship between cardiac surgery and the development of Me-Is.
Main Methods:
- Retrospective analysis of 106 patients who developed Me-Is between 2009-2019 after 22,590 cardiac surgeries.
- Stratification of patients into survivors and nonsurvivors based on outcomes.
- Analysis of baseline characteristics, procedural data, and postoperative management.
Main Results:
- The 30-day survival rate for Me-Is post-cardiac surgery was 49.1%.
- Mortality predictors included high norepinephrine doses (HR 8.29), elevated lactate levels (HR 1.06), and inotrope use (HR 2.46).
- Non-occlusive Me-Is (79.2%) was common, and laparotomy was the primary treatment in both survivor and nonsurvivor groups.
Conclusions:
- The prognosis of Me-Is following cardiac surgery remains poor, irrespective of diagnostic or treatment approaches.
- A critical asymptomatic postoperative period exists where pathophysiological processes become irreversible.
- Once clinical symptoms manifest, the patient's clinical course is difficult to influence.
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