Gastrointestinal complications after cardiac surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Yunyi ¹ , LUO Shuhua ² ,  WANG Rurong ¹

1. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

WANG Rurong, Email: wangrurong@scu.edu.cn

Keywords：

Post-cardiac surgery; gastrointestinal complication; mesenteric ischemia; review

DOI：

10.7507/1007-4848.202105034

Video：

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Gastrointestinal complications after cardiac surgery are rare, but they are associated with significant morbidity and mortality. The mechanisms of gastrointestinal complications after cardiac surgery may be unique, as the abdominal cavity is not involved. This review summarizes the current evidence of the pathophysiology, clinical manifestations, risk factors, and management of gastrointestinal complications after cardiac surgery, aiming to improve the recognition of gastrointestinal complications after cardiac surgery.

Citation： ZHANG Yunyi, LUO Shuhua, WANG Rurong. Gastrointestinal complications after cardiac surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(3): 390-396. doi: 10.7507/1007-4848.202105034 Copy

1.	Rodriguez R, Robich MP, Plate JF, et al. Gastrointestinal complications following cardiac surgery: A comprehensive review. J Card Surg, 2010, 25(2): 188-197.
2.	Chaudhry R, Zaki J, Wegner R, et al. Gastrointestinal complications after cardiac surgery: A nationwide population-based analysis of morbidity and mortality predictors. J Cardiothorac Vasc Anesth, 2017, 31(4): 1268-1274.
3.	Soylu L, Aydın OU, Yıldız M, et al. Comparison of intestinal ischemia after on-pump versus off-pump coronary artery bypass grafting surgery. Turk J Med Sci, 2019, 49(1): 11-15.
4.	Gelman S, Mushlin PS. Catecholamine-induced changes in the splanchnic circulation affecting systemic hemodynamics. Anesthesiology, 2004, 100(2): 434-439.
5.	Hessel EA. Abdominal organ injury after cardiac surgery. Semin Cardiothorac Vasc Anesth, 2004, 8(3): 243-263.
6.	Viana FF, Chen Y, Almeida AA, et al. Gastrointestinal complications after cardiac surgery: 10-year experience of a single Australian centre. ANZ J Surg, 2013, 83(9): 651-656.
7.	D'Ancona G, Baillot R, Poirier B, et al. Determinants of gastrointestinal complications in cardiac surgery. Tex Heart Inst J, 2003, 30(4): 280-285.
8.	Chor CYT, Mahmood S, Khan IH, et al. Gastrointestinal complications following cardiac surgery. Asian Cardiovasc Thorac Ann, 2020, 28(9): 621-632.
9.	Byhahn C, Strouhal U, Martens S, et al. Incidence of gastrointestinal complications in cardiopulmonary bypass patients. World J Surg, 2001, 25(9): 1140-1144.
10.	Haywood N, Mehaffey JH, Hawkins RB, et al. Gastrointestinal complications after cardiac surgery: Highly morbid but improving over time. J Surg Res, 2020, 254: 306-313.
11.	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.
12.	Sever K, Ozbek C, Goktas B, et al. Gastrointestinal complications after open heart surgery: Incidence and determinants of risk factors. Angiology, 2014, 65(5): 425-429.
13.	Ohri SK, Velissaris T. Gastrointestinal dysfunction following cardiac surgery. Perfusion, 2006, 21(4): 215-223.
14.	Moneta GL, Misbach GA, Ivey TD. Hypoperfusion as a possible factor in the development of gastrointestinal complications after cardiac surgery. Am J Surg, 1985, 149(5): 648-650.
15.	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.
16.	Allen SJ. Gastrointestinal complications and cardiac surgery. J Extra Corpor Technol, 2014, 46(2): 142-149.
17.	Scott-Douglas NW, Robinson VJ, Smiseth OA, et al. Effects of acute volume loading and hemorrhage on intestinal vascular capacitance: A mechanism whereby capacitance modulates cardiac output. Can J Cardiol, 2002, 18(5): 515-522.
18.	Mutlu GM, Mutlu EA, Factor P. GI complications in patients receiving mechanical ventilation. Chest, 2001, 119(4): 1222-1241.
19.	Blauth CI, Cosgrove DM, Webb BW, et al. Atheroembolism from the ascending aorta. An emerging problem in cardiac surgery. J Thorac Cardiovasc Surg, 1992, 103(6): 1104-1111.
20.	Rätz 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(1): 128-134.
21.	Farmer AD, Holt CB, Downes TJ, et al. Pathophysiology, diagnosis, and management of opioid-induced constipation. Lancet Gastroenterol Hepatol, 2018, 3(3): 203-212.
22.	Bhat M, Larocque M, Amorim M, et al. Prediction and prevention of upper gastrointestinal bleeding after cardiac surgery: A case control study. Can J Gastroenterol, 2012, 26(6): 340-344.
23.	Krawiec F, Maitland A, Duan Q, et al. Duodenal ulcers are a major cause of gastrointestinal bleeding after cardiac surgery. J Thorac Cardiovasc Surg, 2017, 154(1): 181-188.
24.	Lim JY, Kim JB, Jung SH, et al. Risk factor analysis for nonocclusive mesenteric ischemia following cardiac surgery: A case-control study. Medicine (Baltimore), 2017, 96(37): e8029.
25.	Eris C, Yavuz S, Yalcinkaya S, et al. Acute mesenteric ischemia after cardiac surgery: An analysis of 52 patients. Sci World J, 2013, 2013: 631534.
26.	Dhatt HS, Behr SC, Miracle A, et al. Radiological evaluation of bowel ischemia. Radiol Clin North Am, 2015, 53(6): 1241-1254.
27.	Pang PY, Sin YK, Lim CH, et al. Outcome and survival analysis of intestinal ischaemia following cardiac surgery. Interact Cardiovasc Thorac Surg, 2012, 15(2): 215-218.
28.	Abboud B, Daher R, Boujaoude J. Acute mesenteric ischemia after cardio-pulmonary bypass surgery. World J Gastroenterol, 2008, 14(35): 5361-5370.
29.	Zogheib E, Cosse C, Sabbagh C, et al. Biological scoring system for early prediction of acute bowel ischemia after cardiac surgery: The PALM score. Ann Intensive Care, 2018, 8(1): 46.
30.	Chacon MM, Schulte TE. Liver dysfunction in cardiac surgery—What causes it and is there anything we can do? J Cardiothorac Vasc Anesth, 2018, 32(4): 1719-1721.
31.	Damasceno TA, Scorzoni A, Chahud F, et al. Cardiopulmonary bypass ischemic hepatitis reported in five patients. Braz J Cardiovasc Surg, 2016, 31(4): 330-333.
32.	Berson AJ, Smith JM, Woods SE, et al. Off-pump versus on-pump coronary artery bypass surgery: Does the pump influence outcome? J Am Coll Surg, 2004, 199(1): 102-108.
33.	Raja SG, Haider Z, Ahmad M. Predictors of gastrointestinal complications after conventional and beating heart coronary surgery. Surgeon, 2003, 1(4): 221-228.
34.	Díaz-Gómez JL, Nutter B, Xu M, et al. The effect of postoperative gastrointestinal complications in patients undergoing coronary artery bypass surgery. Ann Thorac Surg, 2010, 90(1): 109-115.
35.	Demir B, Caglar IM, Ugurlucan M, et al. The relationship between severity of calcific aortic stenosis and serum uric acid levels. Angiology, 2012, 63(8): 603-608.
36.	Golitaleb M, Golaghaie F, Mousavi MS, et al. Gastrointestinal complications after cardiac surgery. Iran Heart J, 2019, 20(2): 56-61.
37.	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.
38.	Dong G, Liu C, Xu B, et al. Postoperative abdominal complications after cardiopulmonary bypass. J Cardiothorac Surg, 2012, 7: 108.
39.	Marsoner K, Voetsch A, Lierzer C, et al. Gastrointestinal complications following on-pump cardiac surgery—A propensity matched analysis. PLoS One, 2019, 14(6): e0217874.
40.	Ghosh S, Roberts N, Firmin RK, et al. Risk factors for intestinal ischaemia in cardiac surgical patients. Eur J Cardiothorac Surg, 2002, 21(3): 411-416.
41.	Seilitz J, Edström M, Sköldberg M, et al. Early onset of postoperative gastrointestinal dysfunction is associated with unfavorable outcome in cardiac surgery: A prospective observational study. J Intensive Care Med, 2020, 885066620946006.
42.	Sanisoglu I, Guden M, Bayramoglu Z, et al. Does off-pump CABG reduce gastrointestinal complications? Ann Thorac Surg, 2004, 77(2): 619-625.
43.	Hata M, Shiono M, Sekino H, et al. Prospective randomized trial for optimal prophylactic treatment of the upper gastrointestinal complications after open heart surgery. Circ J, 2005, 69(3): 331-334.
44.	Andersson B, Andersson R, Brandt J, et al. Gastrointestinal complications after cardiac surgery - improved risk stratification using a new scoring model. Interact Cardiovasc Thorac Surg, 2010, 10(3): 366-370.
45.	Fiore G, Brienza N, Cicala P, et al. Superior mesenteric artery blood flow modifications during off-pump coronary surgery. Ann Thorac Surg, 2006, 82(1): 62-67.
46.	Aljarallah B, Wong W, Modry D, et al. Prevalence and outcome of upper gastrointestinal bleeding post-coronary artery bypass graft. Int J Health Sci (Qassim), 2008, 2(1): 69-76.
47.	Eom CS, Jeon CY, Lim JW, et al. Use of acid-suppressive drugs and risk of pneumonia: A systematic review and meta-analysis. CMAJ, 2011, 183(3): 310-319.
48.	Othman F, Crooks CJ, Card TR. Community acquired pneumonia incidence before and after proton pump inhibitor prescription: Population based study. BMJ, 2016, 355: i5813.
49.	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.
50.	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 J Anaesth, 2013, 110(5): 721-728.
51.	Giglio MT, Marucci M, Testini M, et al. Goal-directed haemodynamic therapy and gastrointestinal complications in major surgery: A meta-analysis of randomized controlled trials. Br J Anaesth, 2009, 103(5): 637-646.
52.	El-Halawany H, Bajwa A, Shobassy M, et al. Ischemic colitis caused by intra-aortic balloon pump counterpulsation. Case Rep Gastrointest Med, 2015, 2015: 747989.
53.	Yap KH, Chua KC, Lim SL, et al. Is it possible to predict the risk of ischaemic bowel after cardiac surgery? Interact Cardiovasc Thorac Surg, 2014, 19(3): 494-498.
54.	Theodoropoulos G, Lloyd LR, Cousins G, et al. Intraoperative and early postoperative gastric intramucosal pH predicts morbidity and mortality after major abdominal surgery. Am Surg, 2001, 67(4): 303-308.
55.	Reintam Blaser A, Malbrain ML, Starkopf J, et al. Gastrointestinal function in intensive care patients: Terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems. Intensive Care Med, 2012, 38(3): 384-394.

1. Rodriguez R, Robich MP, Plate JF, et al. Gastrointestinal complications following cardiac surgery: A comprehensive review. J Card Surg, 2010, 25(2): 188-197.
2. Chaudhry R, Zaki J, Wegner R, et al. Gastrointestinal complications after cardiac surgery: A nationwide population-based analysis of morbidity and mortality predictors. J Cardiothorac Vasc Anesth, 2017, 31(4): 1268-1274.
3. Soylu L, Aydın OU, Yıldız M, et al. Comparison of intestinal ischemia after on-pump versus off-pump coronary artery bypass grafting surgery. Turk J Med Sci, 2019, 49(1): 11-15.
4. Gelman S, Mushlin PS. Catecholamine-induced changes in the splanchnic circulation affecting systemic hemodynamics. Anesthesiology, 2004, 100(2): 434-439.
5. Hessel EA. Abdominal organ injury after cardiac surgery. Semin Cardiothorac Vasc Anesth, 2004, 8(3): 243-263.
6. Viana FF, Chen Y, Almeida AA, et al. Gastrointestinal complications after cardiac surgery: 10-year experience of a single Australian centre. ANZ J Surg, 2013, 83(9): 651-656.
7. D'Ancona G, Baillot R, Poirier B, et al. Determinants of gastrointestinal complications in cardiac surgery. Tex Heart Inst J, 2003, 30(4): 280-285.
8. Chor CYT, Mahmood S, Khan IH, et al. Gastrointestinal complications following cardiac surgery. Asian Cardiovasc Thorac Ann, 2020, 28(9): 621-632.
9. Byhahn C, Strouhal U, Martens S, et al. Incidence of gastrointestinal complications in cardiopulmonary bypass patients. World J Surg, 2001, 25(9): 1140-1144.
10. Haywood N, Mehaffey JH, Hawkins RB, et al. Gastrointestinal complications after cardiac surgery: Highly morbid but improving over time. J Surg Res, 2020, 254: 306-313.
11. 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.
12. Sever K, Ozbek C, Goktas B, et al. Gastrointestinal complications after open heart surgery: Incidence and determinants of risk factors. Angiology, 2014, 65(5): 425-429.
13. Ohri SK, Velissaris T. Gastrointestinal dysfunction following cardiac surgery. Perfusion, 2006, 21(4): 215-223.
14. Moneta GL, Misbach GA, Ivey TD. Hypoperfusion as a possible factor in the development of gastrointestinal complications after cardiac surgery. Am J Surg, 1985, 149(5): 648-650.
15. 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.
16. Allen SJ. Gastrointestinal complications and cardiac surgery. J Extra Corpor Technol, 2014, 46(2): 142-149.
17. Scott-Douglas NW, Robinson VJ, Smiseth OA, et al. Effects of acute volume loading and hemorrhage on intestinal vascular capacitance: A mechanism whereby capacitance modulates cardiac output. Can J Cardiol, 2002, 18(5): 515-522.
18. Mutlu GM, Mutlu EA, Factor P. GI complications in patients receiving mechanical ventilation. Chest, 2001, 119(4): 1222-1241.
19. Blauth CI, Cosgrove DM, Webb BW, et al. Atheroembolism from the ascending aorta. An emerging problem in cardiac surgery. J Thorac Cardiovasc Surg, 1992, 103(6): 1104-1111.
20. Rätz 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(1): 128-134.
21. Farmer AD, Holt CB, Downes TJ, et al. Pathophysiology, diagnosis, and management of opioid-induced constipation. Lancet Gastroenterol Hepatol, 2018, 3(3): 203-212.
22. Bhat M, Larocque M, Amorim M, et al. Prediction and prevention of upper gastrointestinal bleeding after cardiac surgery: A case control study. Can J Gastroenterol, 2012, 26(6): 340-344.
23. Krawiec F, Maitland A, Duan Q, et al. Duodenal ulcers are a major cause of gastrointestinal bleeding after cardiac surgery. J Thorac Cardiovasc Surg, 2017, 154(1): 181-188.
24. Lim JY, Kim JB, Jung SH, et al. Risk factor analysis for nonocclusive mesenteric ischemia following cardiac surgery: A case-control study. Medicine (Baltimore), 2017, 96(37): e8029.
25. Eris C, Yavuz S, Yalcinkaya S, et al. Acute mesenteric ischemia after cardiac surgery: An analysis of 52 patients. Sci World J, 2013, 2013: 631534.
26. Dhatt HS, Behr SC, Miracle A, et al. Radiological evaluation of bowel ischemia. Radiol Clin North Am, 2015, 53(6): 1241-1254.
27. Pang PY, Sin YK, Lim CH, et al. Outcome and survival analysis of intestinal ischaemia following cardiac surgery. Interact Cardiovasc Thorac Surg, 2012, 15(2): 215-218.
28. Abboud B, Daher R, Boujaoude J. Acute mesenteric ischemia after cardio-pulmonary bypass surgery. World J Gastroenterol, 2008, 14(35): 5361-5370.
29. Zogheib E, Cosse C, Sabbagh C, et al. Biological scoring system for early prediction of acute bowel ischemia after cardiac surgery: The PALM score. Ann Intensive Care, 2018, 8(1): 46.
30. Chacon MM, Schulte TE. Liver dysfunction in cardiac surgery—What causes it and is there anything we can do? J Cardiothorac Vasc Anesth, 2018, 32(4): 1719-1721.
31. Damasceno TA, Scorzoni A, Chahud F, et al. Cardiopulmonary bypass ischemic hepatitis reported in five patients. Braz J Cardiovasc Surg, 2016, 31(4): 330-333.
32. Berson AJ, Smith JM, Woods SE, et al. Off-pump versus on-pump coronary artery bypass surgery: Does the pump influence outcome? J Am Coll Surg, 2004, 199(1): 102-108.
33. Raja SG, Haider Z, Ahmad M. Predictors of gastrointestinal complications after conventional and beating heart coronary surgery. Surgeon, 2003, 1(4): 221-228.
34. Díaz-Gómez JL, Nutter B, Xu M, et al. The effect of postoperative gastrointestinal complications in patients undergoing coronary artery bypass surgery. Ann Thorac Surg, 2010, 90(1): 109-115.
35. Demir B, Caglar IM, Ugurlucan M, et al. The relationship between severity of calcific aortic stenosis and serum uric acid levels. Angiology, 2012, 63(8): 603-608.
36. Golitaleb M, Golaghaie F, Mousavi MS, et al. Gastrointestinal complications after cardiac surgery. Iran Heart J, 2019, 20(2): 56-61.
37. 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.
38. Dong G, Liu C, Xu B, et al. Postoperative abdominal complications after cardiopulmonary bypass. J Cardiothorac Surg, 2012, 7: 108.
39. Marsoner K, Voetsch A, Lierzer C, et al. Gastrointestinal complications following on-pump cardiac surgery—A propensity matched analysis. PLoS One, 2019, 14(6): e0217874.
40. Ghosh S, Roberts N, Firmin RK, et al. Risk factors for intestinal ischaemia in cardiac surgical patients. Eur J Cardiothorac Surg, 2002, 21(3): 411-416.
41. Seilitz J, Edström M, Sköldberg M, et al. Early onset of postoperative gastrointestinal dysfunction is associated with unfavorable outcome in cardiac surgery: A prospective observational study. J Intensive Care Med, 2020, 885066620946006.
42. Sanisoglu I, Guden M, Bayramoglu Z, et al. Does off-pump CABG reduce gastrointestinal complications? Ann Thorac Surg, 2004, 77(2): 619-625.
43. Hata M, Shiono M, Sekino H, et al. Prospective randomized trial for optimal prophylactic treatment of the upper gastrointestinal complications after open heart surgery. Circ J, 2005, 69(3): 331-334.
44. Andersson B, Andersson R, Brandt J, et al. Gastrointestinal complications after cardiac surgery - improved risk stratification using a new scoring model. Interact Cardiovasc Thorac Surg, 2010, 10(3): 366-370.
45. Fiore G, Brienza N, Cicala P, et al. Superior mesenteric artery blood flow modifications during off-pump coronary surgery. Ann Thorac Surg, 2006, 82(1): 62-67.
46. Aljarallah B, Wong W, Modry D, et al. Prevalence and outcome of upper gastrointestinal bleeding post-coronary artery bypass graft. Int J Health Sci (Qassim), 2008, 2(1): 69-76.
47. Eom CS, Jeon CY, Lim JW, et al. Use of acid-suppressive drugs and risk of pneumonia: A systematic review and meta-analysis. CMAJ, 2011, 183(3): 310-319.
48. Othman F, Crooks CJ, Card TR. Community acquired pneumonia incidence before and after proton pump inhibitor prescription: Population based study. BMJ, 2016, 355: i5813.
49. 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.
50. 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 J Anaesth, 2013, 110(5): 721-728.
51. Giglio MT, Marucci M, Testini M, et al. Goal-directed haemodynamic therapy and gastrointestinal complications in major surgery: A meta-analysis of randomized controlled trials. Br J Anaesth, 2009, 103(5): 637-646.
52. El-Halawany H, Bajwa A, Shobassy M, et al. Ischemic colitis caused by intra-aortic balloon pump counterpulsation. Case Rep Gastrointest Med, 2015, 2015: 747989.
53. Yap KH, Chua KC, Lim SL, et al. Is it possible to predict the risk of ischaemic bowel after cardiac surgery? Interact Cardiovasc Thorac Surg, 2014, 19(3): 494-498.
54. Theodoropoulos G, Lloyd LR, Cousins G, et al. Intraoperative and early postoperative gastric intramucosal pH predicts morbidity and mortality after major abdominal surgery. Am Surg, 2001, 67(4): 303-308.
55. Reintam Blaser A, Malbrain ML, Starkopf J, et al. Gastrointestinal function in intensive care patients: Terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems. Intensive Care Med, 2012, 38(3): 384-394.

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