scholarly journals Gastrointestinal Complications after Cardiopulmonary Bypass: Sixteen Years of Experience

2005 ◽  
Vol 19 (10) ◽  
pp. 613-617 ◽  
Author(s):  
Cengiz Bolcal ◽  
Hikmet Iyem ◽  
Murat Sargin ◽  
Ilker Mataraci ◽  
Mehmet Ali şahin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Artery Bypass ◽  
Case Fatality ◽  
Gastrointestinal Complications ◽  
Major Morbidity ◽  
Risk Patients ◽  
Cardiac Operations ◽  
Overall Mortality

BACKGROUND: Gastrointestinal (GI) complications are one of the serious complications of cardiac surgery. Although rarely seen, they cause major morbidity and mortality. The aim of the present study was to retrospectively analyze the risk factors acting on the GI complications seen after cardiac operations performed under cardiopulmonary bypass.METHOD: The present study was designed to retrospectively evaluate 13,544 patients who underwent cardiac surgery under cardiopulmonary bypass, between 1988 and 2004 in the authors' clinic.RESULTS: The overall mortality was 346 (2.55%) of 13,544 patients. GI complications developed in 128 patients (0.94%). Among those, 18 (14.1%) died because of GI complications, the most common of which was bleeding. Mesenteric ischemia had the highest case-fatality rate at 71.4%. Valve surgery, concomitant valve and coronary artery bypass grafting surgery, preoperative chronic renal dysfunction, postoperative acute renal failure, deep sternal infection, prolonged ventilation, need for intra-aortic balloon pump and ejection fraction less than 30% were found to be risk factors acting on GI complications.CONCLUSION: GI complications remain a significant concern after cardiac surgery under cardiopulmonary bypass. Higher-risk patients can be identified and treated prophylactically and in the postoperative period.

Plasma endotoxin concentrations during cardiac surgery may be related to atherosclerosis

Perfusion ◽  
2000 ◽  
Vol 15 (5) ◽  
pp. 421-426 ◽  
Author(s):  
Vibeke Videm ◽  
Jan L Svennevig ◽  
Erik Fosse ◽  
Brit Mohr ◽  
Ansgar O Aasen
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Complications ◽  
Valve Replacement ◽  
Artery Bypass ◽  
Elective Cardiac Surgery ◽  
Plasma Endotoxin ◽  
Systemic Endotoxemia ◽  
Risk Patients ◽  
The Relationship ◽  
Cardiac Operations

Systemic endotoxemia develops during cardiopulmonary bypass, probably due to intestinal ischaemia. Differences in endotoxaemia among various cardiac operations and the relationship between endotoxemia and postoperative complications were studied in high-risk patients. Blood samples were obtained at termination of bypass in 136 adults undergoing elective cardiac surgery. Postoperative complications were registered prospectively. Plasma endotoxin was quantified by a kinetic limulus amebocyte lysate assay. Mean endotoxin concentrations were significantly lower in patients undergoing isolated valve replacement (89 ng/l) than in patients undergoing coronary artery bypass grafting alone (234 ng/l), or combined with valve replacement (278 ng/l) or carotid artery surgery (321 ng/l) ( p < 0.05). In multivariate linear regression, only the number of grafts (0, 1-3, 4-5) was significantly correlated to endotoxin concentrations ( p < 0.0005). Endotoxin concentrations were related to development of gastrointestinal dysfunction ( p = 0.03), but not to mortality ( p = 0.24) or other complications ( p = 0.62).

scholarly journals The correlation between bowel complications and cardiac surgery

2020 ◽  
pp. 145749692098361
Author(s):  
V. Mishra ◽  
S. Hewage ◽  
S. Islam ◽  
A. Harky
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Surgical Outcomes ◽  
Cardiac Patients ◽  
Gastrointestinal Complications ◽  
Improved Outcomes ◽  
Underlying Causes ◽  
Insight Into ◽  
Cardiac Operations

Although advances in knowledge and technology have improved outcomes in surgical cardiac patients over the last decade, complications following cardiac operations still remain to be potentially fatal. Gastrointestinal complications, in particular, tend to have high rates of reintervention and mortality following cardiac surgery, with ischemia and hemorrhage being two of the commonest underlying causes. The intention of this review is to identify which risk factors play important roles in predisposing patients to such complications and to gain better insight into the pathogenesis of the sequelae. Furthermore, strategies for prevention have been discussed to educate and increase awareness of how adverse cardiac surgical outcomes can be minimized.

Perioperative intraperitoneal metabolic markers in patients undergoing cardiac surgery with cardiopulmonary bypass: an exploratory pilot study

Perfusion ◽  
2019 ◽  
Vol 34 (7) ◽  
pp. 552-560
Author(s):  
Jenny Seilitz ◽  
Mårten Vidlund ◽  
Birger Axelsson ◽  
Kristofer F Nilsson ◽  
Lars Norgren ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Artery Bypass ◽  
Venous Blood ◽  
Lactate Concentration ◽  
Gas Analysis ◽  
Gastrointestinal Complications ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Perioperative Course

Background: Cardiopulmonary bypass and postoperative cardiac dysfunction cause splanchnic hypoperfusion resulting in intra-abdominal anaerobic metabolism and risk for gastrointestinal complications. The intra-abdominal metabolism can be monitored by intraperitoneal measurement of relevant metabolites using microdialysis. The aim of this study was to investigate the intraperitoneal metabolism using microdialysis during and after cardiopulmonary bypass at 34°C. Methods: In six patients undergoing elective coronary artery bypass grafting or aortic valve replacement under cardiopulmonary bypass, microdialysis was used to measure intraperitoneal and subcutaneous glucose, lactate, pyruvate, glycerol and glutamate concentrations, intraoperatively and up to 36 hours postoperatively. Arterial and central venous blood gases were analysed as were haemodynamics and the development of complications. Results: All patients had an ordinary perioperative course and did not develop gastrointestinal complications. The arterial, intraperitoneal and subcutaneous lactate concentrations changed during the perioperative course with differences between compartments. The highest median (interquartile range) concentration was recorded in the intraperitoneal compartment at 1 hour after the end of cardiopulmonary bypass (2.1 (1.9–2.5) mM compared to 1.3 (1.2–1.7) mM and 1.5 (1.0–2.2) mM in the arterial and subcutaneous compartments, respectively). In parallel with the peak increase in lactate concentration, the intraperitoneal lactate/pyruvate ratio was elevated to 33.4 (12.9–54.1). Conclusion: In cardiac surgery, intraperitoneal microdialysis detected changes in the abdominal metabolic state, which were more pronounced than could be shown by arterial blood gas analysis. Despite an uneventful perioperative course, patients undergoing low-risk surgery under cardiopulmonary bypass might be subjected to a limited and subclinical intra-abdominal anaerobic state.

scholarly journals Effect of sevoflurane on the inflammatory response during cardiopulmonary bypass in cardiac surgery: the study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Thiago Augusto Azevedo Maranhão Cardoso ◽  
Gudrun Kunst ◽  
Caetano Nigro Neto ◽  
José de Ribamar Costa Júnior ◽  
Carlos Gustavo Santos Silva ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Inflammatory Response ◽  
Controlled Trial ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Volatile Anesthetic ◽  
Serum Levels ◽  
Randomized Controlled

Abstract Background Recent experimental evidence shows that sevoflurane can reduce the inflammatory response during cardiac surgery with cardiopulmonary bypass. However, this observation so far has not been assessed in an adequately powered randomized controlled trial. Methods We plan to include one hundred patients undergoing elective coronary artery bypass graft with cardiopulmonary bypass who will be randomized to receive either volatile anesthetics during cardiopulmonary bypass or total intravenous anesthesia. The primary endpoint of the study is to assess the inflammatory response during cardiopulmonary bypass by measuring PMN-elastase serum levels. Secondary endpoints include serum levels of other pro-inflammatory markers (IL-1β, IL-6, IL-8, TNFα), anti-inflammatory cytokines (TGFβ and IL-10), and microRNA expression in peripheral blood to achieve possible epigenetic mechanisms in this process. In addition clinical endpoints such as presence of major complications in the postoperative period and length of hospital and intensive care unit stay will be assessed. Discussion The trial may determine whether adding volatile anesthetic during cardiopulmonary bypass will attenuate the inflammatory response. Trial registration ClinicalTrials.gov NCT02672345. Registered on February 2016 and updated on June 2020.

scholarly journals Clinical, biochemical and genetic risk factors for 30-day and 5-year mortality in 518 adult patients subjected to cardiopulmonary bypass during cardiac surgery - the INFLACOR study.

2018 ◽  
Vol 65 (2) ◽  
pp. 241-250 ◽  
Author(s):  
Maciej Michał Kowalik ◽  
Romuald Lango ◽  
Piotr Siondalski ◽  
Magdalena Chmara ◽  
Maciej Brzeziński ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Genetic Association ◽  
Biochemical Parameters ◽  
Cox Regression ◽  
Association Studies ◽  
Nyha Class ◽  
Genetic Association Studies ◽  
Chronic Obstructive

There is increasing evidence that genetic variability influence patients’ early morbidity after cardiac surgery performed using cardiopulmonary bypass (CPB). The use of mortality as an outcome measure in cardiac surgical genetic association studies is rare. We publish the 30-day and 5-year survival analyses with focus on pre-, intra-, postoperative variables, biochemical parameters, and genetic variants in the INFLACOR (INFlAmmation in Cardiac OpeRations) cohort.In a series of prospectively recruited 518 adult Polish Caucasians who underwent cardiac surgery in which CPB was used, the clinical data, biochemical parameters, IL-6, soluble ICAM-1, TNFa, soluble E-selectin, and 10 single nucleotide polymorphisms were evaluated for their associations with 30-day and 5-year mortality.The 30-day mortality was associated with: pre-operative prothrombin international normalized ratio, intra-operative blood lactate, postoperative serum creatine phosphokinase, and acute kidney injury requiring renal replacement therapy (AKI-RRT) in logistic regression. Factors that determined the 5-year survival included: pre-operative NYHA class, history of peripheral artery disease and severe chronic obstructive pulmonary disease, intra-operative blood transfusion; and postoperative peripheral hypothermia, myocardial infarction, infection, and AKI-RRT in Cox regression. The serum levels of IL-6 and ICAM-1 measured three hours after operation were associated with 30-day and 5-year mortality, respectively. The ICAM1 rs5498 was associated with 30-day and 5-year survival with borderline significance.Different risk factors determined the early (30-day) and late (5-year) survival after adult cardiac surgery in which cardiopulmonary bypass was used. Future genetic association studies in cardiac surgical patients should adjust for the identified chronic and acute postoperative risk factors.

scholarly journals Surgical Explantation of Transcatheter Aortic Valve Bioprostheses

2021 ◽  
Vol 14 (4) ◽  
Author(s):  
Alexander A. Brescia ◽  
G. Michael Deeb ◽  
Stephane Leung Wai Sang ◽  
Daizo Tanaka ◽  
P. Michael Grossman ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Aortic Valve ◽  
Operative Mortality ◽  
Artery Bypass ◽  
Paravalvular Leak ◽  
Transcatheter Aortic Valve ◽  
Risk Of Mortality ◽  
Risk Patients ◽  
Transcatheter Valve ◽  
Predicted Risk

Background: Despite the rapid adoption of transcatheter aortic valve replacement (TAVR) since its initial approval in 2011, the frequency and outcomes of surgical explantation of TAVR devices (TAVR-explant) is poorly understood. Methods: Patients undergoing TAVR-explant between January 2012 and June 2020 at 33 hospitals in Michigan were identified in the Society of Thoracic Surgeons Database and linked to index TAVR data from the Transcatheter Valve Therapy Registry through a statewide quality collaborative. The primary outcome was operative mortality. Indications for TAVR-explant, contraindications to redo TAVR, operative data, and outcomes were collected from Society of Thoracic Surgeons and Transcatheter Valve Therapy databases. Baseline Society of Thoracic Surgeons Predicted Risk of Mortality was compared between index TAVR and TAVR-explant. Results: Twenty-four surgeons at 12 hospitals performed TAVR-explants in 46 patients (median age, 73). The frequency of TAVR-explant was 0.4%, and the number of explants increased annually. Median time to TAVR-explant was 139 days and among known device types explanted, most were self-expanding valves (29/41, 71%). Common indications for TAVR-explant were procedure-related failure (35%), paravalvular leak (28%), and need for other cardiac surgery (26%). Contraindications to redo TAVR included need for other cardiac surgery (28%), unsuitable noncoronary anatomy (13%), coronary obstruction (11%), and endocarditis (11%). Overall, 65% (30/46) of patients underwent concomitant procedures, including aortic repair/replacement in 33% (n=15), mitral surgery in 22% (n=10), and coronary artery bypass grafting in 16% (n=7). The median Society of Thoracic Surgeons Predicted Risk of Mortality was 4.2% at index TAVR and 9.3% at TAVR-explant ( P =0.001). Operative mortality was 20% (9/46) and 76% (35/46) of patients had in-hospital complications. Of patients alive at discharge, 37% (17/37) were discharged home and overall 3-month survival was 73±14%. Conclusions: TAVR-explant is rare but increasing, and its clinical impact is substantial. As the utilization of TAVR expands into younger and lower-risk patients, providers should consider the potential for future TAVR-explant during selection of an initial valve strategy.

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