PMID- 15912039
OWN - NLM
STAT- MEDLINE
DCOM- 20050624
LR  - 20231105
IS  - 0003-4932 (Print)
IS  - 1528-1140 (Electronic)
IS  - 0003-4932 (Linking)
VI  - 241
IP  - 6
DP  - 2005 Jun
TI  - Gastrointestinal complications in patients undergoing heart operation: an 
      analysis of 8709 consecutive cardiac surgical patients.
PG  - 895-901; discussion 901-4
AB  - INTRODUCTION: Gastrointestinal (GI) complications following heart operation may 
      be life-threatening. Systematic analysis of risk factors to allow early 
      identification of patients at risk for GI complication may lead to the 
      development of strategies to mitigate this complication as well as to optimize 
      management after its occurrence. METHODS: Of 8709 consecutive patients undergoing 
      heart operation during 7 years (1997-2003), 46 (0.53%) developed GI complications 
      requiring surgical consultation. Preoperative, intraoperative, and postoperative 
      predictors of complication and death were identified and compared with a control 
      group. RESULTS: Significant (P < 0.05) preoperative predictors of complication 
      were prior cerebrovascular accident (CVA), chronic obstructive pulmonary disease 
      (COPD), type II heparin-induced thrombocytopenia, atrial fibrillation, prior 
      myocardial infarction, renal insufficiency, hypertension, and need for 
      intra-aortic balloon counter-pulsation. The most frequent serious GI complication 
      was mesenteric ischemia, which developed in 31 (67%) patients. Twenty-two (71%) 
      of these patients were explored, and 14 (64%) died within 2 days of heart 
      operation. Of the 9 patients with mesenteric ischemia who were not explored, 7 
      (78%) died within 3 days of heart operation. Other complications included 
      diverticulitis (5), pancreatitis (4), peptic ulcer disease (4), and cholecystitis 
      (2). The mortality rate in this group of other diagnoses was lower (40%), and 
      death occurred later (32 days) after heart operation (P = 0.03 compared with 
      mesenteric ischemia). Predictors of death from GI complication included New York 
      Heart Association (NYHA) class III and IV heart failure, smoking, chronic 
      obstructive pulmonary disease, history of syncope, aspartate aminotransferase 
      (AST) >600 U/L, direct bilirubin >2.4 mg/dL, pH < 7.30, and the need for >2 
      pressors. CONCLUSIONS: The most common catastrophic GI 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.
FAU - Mangi, Abeel A
AU  - Mangi AA
AD  - Division of General and Gastrointestinal Surgery, Department of Surgery, 
      Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 
      02114, USA.
FAU - Christison-Lagay, Emily R
AU  - Christison-Lagay ER
FAU - Torchiana, David F
AU  - Torchiana DF
FAU - Warshaw, Andrew L
AU  - Warshaw AL
FAU - Berger, David L
AU  - Berger DL
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Ann Surg
JT  - Annals of surgery
JID - 0372354
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cardiac Surgical Procedures/*adverse effects
MH  - Cardiopulmonary Bypass
MH  - Female
MH  - Gastrointestinal Diseases/epidemiology/*etiology/mortality/surgery
MH  - Humans
MH  - Intestines/blood supply
MH  - Ischemia/etiology/surgery
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Splanchnic Circulation
PMC - PMC1357169
EDAT- 2005/05/25 09:00
MHDA- 2005/06/25 09:00
PMCR- 2005/12/01
CRDT- 2005/05/25 09:00
PHST- 2005/05/25 09:00 [pubmed]
PHST- 2005/06/25 09:00 [medline]
PHST- 2005/05/25 09:00 [entrez]
PHST- 2005/12/01 00:00 [pmc-release]
AID - 00000658-200506000-00007 [pii]
AID - 0000658-200506000-00007 [pii]
AID - 10.1097/01.sla.0000164173.05762.32 [doi]
PST - ppublish
SO  - Ann Surg. 2005 Jun;241(6):895-901; discussion 901-4. doi: 
      10.1097/01.sla.0000164173.05762.32.