Recent advances of gastrointestinal complications after cardiac surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 LI Rong , LI Weiguo , WU Bing , WANG Zhaohui , LI Junfeng , GOU Longfei

Department of Cardiovascular Surgery, Jinzhou Central Hospital, Jinzhou, Liaoning 121000, P.R.China;

Corresponding author：

LI Rong, Email: lrlnjz@163.com

Keywords：

Cardiac surgery; coronary artery bypass grafting; cardiopulmonary bypass; gastrointestinal complications

DOI：

10.7507/1007-4848.201512017

Video：

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Gastrointestinal (GI) complications after heart surgery included slight bleeding through fulminant hepatic failure. Although overall rate of these complications is low, it can lead to high mortality after heart surgery. Diagnosis of GI complication is difficult. Risk factors for GI complications are clear. Mechanisms of complications are various. Therefore, we collected the recent prospective and retrospective literatures to sumarize mortality of GI complications, pathogenesis, risk factors, recent progress of prevention and management, to guide clinical practice.

Citation： LIRong, LIWeiguo, WUBing, WANGZhaohui, LIJunfeng, GOULongfei. Recent advances of gastrointestinal complications after cardiac surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(1): 69-74. doi: 10.7507/1007-4848.201512017 Copy

1.	McSweeney ME, Garwood S, Levin J, et al. Adverse gastrointestinal complications after cardiopulmonary bypass: Can outcome be predicted from preoperative risk factors? Anesth Analg, 2004, 98(6): 1610-1617.
2.	Mangi AA, Christison-Lagay ER, Torchiana DF, et al. Gastrointestinal complications in patients undergoing heart operation. An analysis of 8709 consecutive cardiac surgical patients. Ann Surg, 2005, 241(6): 895-901.
3.	Dong G, Liu C, Xu B, et al. Postoperative abdominal complications after cardiopulmonary bypass. Cardiothorac Surg, 2012, 7: 108.
4.	Tsiotos GG, Mullany CJ, Zietlow S, et al. Abdominal complications following cardiac surgery. Am Surg, 1994, 167(6): 553-557.
5.	Huddy SPJ, Joyce WP, Pepper JR. Gastrointestinal complications in 4473 patients who underwent cardiopulmonary bypass surgery. Br Surg, 1991, 78(3): 293-296.
6.	Ohri SK, Desai JB, Gaer JAR, et al. Intra-abdominal complications following cardiopulmonary bypass. Ann Thorac Surg, 1991, 52(4): 826-831.
7.	Yilmaz AT, Arslan M, Demirkilic U, et al. Gastrointestinal complications after cardiac surgery. Eur Cardiothorac Surg, 1996, 10(9): 763-767.
8.	Rodriguez R, Robich MP, Plate JF, et al. Gastrointestinal complications following cardiac surgery: A comprehensive review. Card Surg, 2010, 25(2): 188-197.
9.	Croome KP, Kiaii B, Fox S, et al. Comparison of gastrointestinal complications in on-pump versus off-pump coronary artery bypass grafting. Can Surg, 2009, 52(2): 125-128.
10.	Ohri SK, Velissaris T. Gastrointestinal dysfunction following cardiac surgery. Perfusion, 2006, 21(4): 215-223.
11.	Moneta GL, Misbach GA, Ivey TD. Hypoperfusion as a possible risk factor in the development of gastrointestinal complications after cardiac surgery. Am Surg, 1985, 149(5): 648-650.
12.	Hessel EA. Abdominal organ injury after cardiac surgery. Semin Cardiothorac Anesth, 2004, 8(5): 243-263.
13.	McNicol L, Lipcsey M, Bellomo R, et al. Pilot alternating treatment design study of the splanchnic metabolic effects of two mean arterial pressure targets during cardiopulmonary bypass. Br Anaesth, 2013, 110(5): 721-728.
14.	Ohri SK, Becket J, Brannan J, et al. Effects of cardiopulmonary bypass on gut blood flow, oxygen utilisation, and intramucosal pH. Ann Thorac Surg, 1994, 57: 1193-1199.
15.	Ohri SK, Bowles CW, Mathie RT, et al. Effect of cardiopulmonary bypass perfusion protocols on gut tissue oxygenation and blood flow. Ann Thorac Surg,1997, 64(1): 163-170.
16.	Sakorafas GH, Tsiotos GG. Intra-abdominal complications after cardiac surgery. Eur Surg, 1999, 165(6): 820-827.
17.	Asimakopoulos G, Taylor KM. The effect of cardiopulmonary bypass on neutrophil and endothelial adhesion molecules. Ann Thorac Surg, 1998, 66: 2135-2144.
18.	Nilsson J, Hansson E, Andersson B. Intestinal ischemia after cardiac surgery: Analysis of a large registry. Cardiothorac Surg, 2013, 8: 156.
19.	D’Ancona G, Baillot R, Poirier B, et al. Determinants of gastrointestinal complications in cardiac surgery. Tex Heart, 2003, 30: 280-285.
20.	Ratz Bravo AE, Drewe J, Schlienger RG, et al. Hepatotoxicity during rapid intravenous loading with amiodarone: Description of three cases and review of the literature. Crit Care Med, 2005, 33(4): 128-134.
21.	Perugini RA, Orr RK, Porter D, et al. Gastrointestinal complications after cardiac surgery. An analysis of 1477 cardiac surgery patients. Arch Surg, 1997, 132(4): 352-357.
22.	Andersson B, Nilsson J, Brandt J, et al. Gastrointestinal complications after cardiac surgery. Br Surg, 2005, 92(3): 326-333.
23.	Musleh GS, Patel NC, Grayson AD, et al. Off-pump coronary artery bypass surgery does not reduce gastrointestinal complications. Eur Cardiothorac Surg, 2003, 23(2): 170-174.
24.	Berson AJ, Smith JM, Woods SE, et al. Off-pump versus on-pump coronary artery bypass surgery: Does the pump influence outcome? Am Coll Surg, 2004, 199(1): 102-108.
25.	Chaudhuri N, James J, Sheikh A, et al. Intestinal ischaemia following cardiac surgery: A multivariate risk model. Eur Cardiothorac Surg, 2006, 29(6): 971-977.
26.	Filsoufi F, Rahmanian PB, Castillo JG, et al. Predictors and outcome of gastrointestinal complications in patients undergoing cardiac surgery. Ann Surg, 2007, 246(2): 323-329.
27.	Andersson B, Andersson R, Brandt J, et al. Gastrointestinal complications after cardiac surgery—Improved risk stratification using a new scoring model. Interact Thorac Cardiovasc Surg, 2010, 10(3): 366-370.
28.	Menkis AH, Martin J, Cheng DC, et al. Drug, devices, technologies, and techniques for blood management in minimally invasive and conventional cardiothoracic surgery: A consensus statement from the International Society for Minimally Invasive Cardiothoracic Surgery (ISMICS) 2011. Innovations, 2012, 7(4): 229-241.
29.	Ott MJ, Buchman TG, Baumgartner WA. Postoperative abdominal complications in cardiopulmonary bypass patients: A case-controlled study. Ann Thorac Surg, 1995, 59(5): 1210-1213.
30.	Mangano DT. Aspirin and mortality from coronary bypass surgery. N Engl Med, 2002, 347(17): 1309-1317.
31.	Mollhoff T, Loick HM, van Aken H, et al. Milrinone modulates endotoxaemia systemic inflammation and subsequent acute phase response after cardiopulmonary bypass. Anesthesiology, 1999, 90(1): 72-80.
32.	Krejci V, Hiltebrand LB, Sigurdsson GH. Effects of epinephrine, norepinephrine, and phenylephrine on microcirculatory blood flow in the gastrointestinal tract in sepsis. Crit Care Med, 2006, 34(5): 1456-1463.
33.	Parviarnen I, Ruokonen E, Takala J. Dobutamine-induced dissociation between changes in splanchnic blood flow and gastric intramucosal pH after cardiac surgery. Br Anaesth, 1995, 74(3): 277-282.
34.	Oldenburg WA, Lau LL, Rodenburg TJ, et al. Acute mesenteric ischemia: A clinical review. Arch Intern Med, 2004, 164(10): 1054-1062.
35.	Bomberg H, Bierbach B, Flache S, et al. Vasopressin induces rectosigmoidal mucosal ischemia during cardiopulmonary bypass. Card Surg, 2014, 29(1): 108-115.
36.	De Foe GR, Ross CS, Olmstead EM, et al. Lowest haematocrit in bypass and adverse outcomes associated with coronary artery bypass grafting. Ann Thorac Surg, 2001, 71(3): 769-776.
37.	Gaer JAR, Shaw ADS, Wild R, et al. Effect of cardiopulmonary bypass on gastrointestinal perfusion and function. Ann Thorac Surg, 1994, 57(3): 371-375.
38.	Patel AJ, Som R. What is the optimum prophylaxis against gastrointestinal haemorrhage for patients undergoing adult cardiac surgery: Histamine receptor antagonists, or proton-pump inhibitors? Interact Cardiovasc Thorac Surg, 2013, 16(3): 356-360.
39.	Eom CS, Jeon CY, Lim KW, et al. Use of acid-supressive drugs and risk of pneumonia: A systematic review and meta-analysis. CMA, 2011, 183(3): 310-319.

1. McSweeney ME, Garwood S, Levin J, et al. Adverse gastrointestinal complications after cardiopulmonary bypass: Can outcome be predicted from preoperative risk factors? Anesth Analg, 2004, 98(6): 1610-1617.
2. Mangi AA, Christison-Lagay ER, Torchiana DF, et al. Gastrointestinal complications in patients undergoing heart operation. An analysis of 8709 consecutive cardiac surgical patients. Ann Surg, 2005, 241(6): 895-901.
3. Dong G, Liu C, Xu B, et al. Postoperative abdominal complications after cardiopulmonary bypass. Cardiothorac Surg, 2012, 7: 108.
4. Tsiotos GG, Mullany CJ, Zietlow S, et al. Abdominal complications following cardiac surgery. Am Surg, 1994, 167(6): 553-557.
5. Huddy SPJ, Joyce WP, Pepper JR. Gastrointestinal complications in 4473 patients who underwent cardiopulmonary bypass surgery. Br Surg, 1991, 78(3): 293-296.
6. Ohri SK, Desai JB, Gaer JAR, et al. Intra-abdominal complications following cardiopulmonary bypass. Ann Thorac Surg, 1991, 52(4): 826-831.
7. Yilmaz AT, Arslan M, Demirkilic U, et al. Gastrointestinal complications after cardiac surgery. Eur Cardiothorac Surg, 1996, 10(9): 763-767.
8. Rodriguez R, Robich MP, Plate JF, et al. Gastrointestinal complications following cardiac surgery: A comprehensive review. Card Surg, 2010, 25(2): 188-197.
9. Croome KP, Kiaii B, Fox S, et al. Comparison of gastrointestinal complications in on-pump versus off-pump coronary artery bypass grafting. Can Surg, 2009, 52(2): 125-128.
10. Ohri SK, Velissaris T. Gastrointestinal dysfunction following cardiac surgery. Perfusion, 2006, 21(4): 215-223.
11. Moneta GL, Misbach GA, Ivey TD. Hypoperfusion as a possible risk factor in the development of gastrointestinal complications after cardiac surgery. Am Surg, 1985, 149(5): 648-650.
12. Hessel EA. Abdominal organ injury after cardiac surgery. Semin Cardiothorac Anesth, 2004, 8(5): 243-263.
13. McNicol L, Lipcsey M, Bellomo R, et al. Pilot alternating treatment design study of the splanchnic metabolic effects of two mean arterial pressure targets during cardiopulmonary bypass. Br Anaesth, 2013, 110(5): 721-728.
14. Ohri SK, Becket J, Brannan J, et al. Effects of cardiopulmonary bypass on gut blood flow, oxygen utilisation, and intramucosal pH. Ann Thorac Surg, 1994, 57: 1193-1199.
15. Ohri SK, Bowles CW, Mathie RT, et al. Effect of cardiopulmonary bypass perfusion protocols on gut tissue oxygenation and blood flow. Ann Thorac Surg,1997, 64(1): 163-170.
16. Sakorafas GH, Tsiotos GG. Intra-abdominal complications after cardiac surgery. Eur Surg, 1999, 165(6): 820-827.
17. Asimakopoulos G, Taylor KM. The effect of cardiopulmonary bypass on neutrophil and endothelial adhesion molecules. Ann Thorac Surg, 1998, 66: 2135-2144.
18. Nilsson J, Hansson E, Andersson B. Intestinal ischemia after cardiac surgery: Analysis of a large registry. Cardiothorac Surg, 2013, 8: 156.
19. D’Ancona G, Baillot R, Poirier B, et al. Determinants of gastrointestinal complications in cardiac surgery. Tex Heart, 2003, 30: 280-285.
20. Ratz Bravo AE, Drewe J, Schlienger RG, et al. Hepatotoxicity during rapid intravenous loading with amiodarone: Description of three cases and review of the literature. Crit Care Med, 2005, 33(4): 128-134.
21. Perugini RA, Orr RK, Porter D, et al. Gastrointestinal complications after cardiac surgery. An analysis of 1477 cardiac surgery patients. Arch Surg, 1997, 132(4): 352-357.
22. Andersson B, Nilsson J, Brandt J, et al. Gastrointestinal complications after cardiac surgery. Br Surg, 2005, 92(3): 326-333.
23. Musleh GS, Patel NC, Grayson AD, et al. Off-pump coronary artery bypass surgery does not reduce gastrointestinal complications. Eur Cardiothorac Surg, 2003, 23(2): 170-174.
24. Berson AJ, Smith JM, Woods SE, et al. Off-pump versus on-pump coronary artery bypass surgery: Does the pump influence outcome? Am Coll Surg, 2004, 199(1): 102-108.
25. Chaudhuri N, James J, Sheikh A, et al. Intestinal ischaemia following cardiac surgery: A multivariate risk model. Eur Cardiothorac Surg, 2006, 29(6): 971-977.
26. Filsoufi F, Rahmanian PB, Castillo JG, et al. Predictors and outcome of gastrointestinal complications in patients undergoing cardiac surgery. Ann Surg, 2007, 246(2): 323-329.
27. Andersson B, Andersson R, Brandt J, et al. Gastrointestinal complications after cardiac surgery—Improved risk stratification using a new scoring model. Interact Thorac Cardiovasc Surg, 2010, 10(3): 366-370.
28. Menkis AH, Martin J, Cheng DC, et al. Drug, devices, technologies, and techniques for blood management in minimally invasive and conventional cardiothoracic surgery: A consensus statement from the International Society for Minimally Invasive Cardiothoracic Surgery (ISMICS) 2011. Innovations, 2012, 7(4): 229-241.
29. Ott MJ, Buchman TG, Baumgartner WA. Postoperative abdominal complications in cardiopulmonary bypass patients: A case-controlled study. Ann Thorac Surg, 1995, 59(5): 1210-1213.
30. Mangano DT. Aspirin and mortality from coronary bypass surgery. N Engl Med, 2002, 347(17): 1309-1317.
31. Mollhoff T, Loick HM, van Aken H, et al. Milrinone modulates endotoxaemia systemic inflammation and subsequent acute phase response after cardiopulmonary bypass. Anesthesiology, 1999, 90(1): 72-80.
32. Krejci V, Hiltebrand LB, Sigurdsson GH. Effects of epinephrine, norepinephrine, and phenylephrine on microcirculatory blood flow in the gastrointestinal tract in sepsis. Crit Care Med, 2006, 34(5): 1456-1463.
33. Parviarnen I, Ruokonen E, Takala J. Dobutamine-induced dissociation between changes in splanchnic blood flow and gastric intramucosal pH after cardiac surgery. Br Anaesth, 1995, 74(3): 277-282.
34. Oldenburg WA, Lau LL, Rodenburg TJ, et al. Acute mesenteric ischemia: A clinical review. Arch Intern Med, 2004, 164(10): 1054-1062.
35. Bomberg H, Bierbach B, Flache S, et al. Vasopressin induces rectosigmoidal mucosal ischemia during cardiopulmonary bypass. Card Surg, 2014, 29(1): 108-115.
36. De Foe GR, Ross CS, Olmstead EM, et al. Lowest haematocrit in bypass and adverse outcomes associated with coronary artery bypass grafting. Ann Thorac Surg, 2001, 71(3): 769-776.
37. Gaer JAR, Shaw ADS, Wild R, et al. Effect of cardiopulmonary bypass on gastrointestinal perfusion and function. Ann Thorac Surg, 1994, 57(3): 371-375.
38. Patel AJ, Som R. What is the optimum prophylaxis against gastrointestinal haemorrhage for patients undergoing adult cardiac surgery: Histamine receptor antagonists, or proton-pump inhibitors? Interact Cardiovasc Thorac Surg, 2013, 16(3): 356-360.
39. Eom CS, Jeon CY, Lim KW, et al. Use of acid-supressive drugs and risk of pneumonia: A systematic review and meta-analysis. CMA, 2011, 183(3): 310-319.

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