VISCERAL COMPLICATIONS FOLLOWING CARDIAC SURGERY WITH CARDIOPULMONARY BYPASS: RELEVANCE, MECHANISMS, PROGNOSIS AND MANAGEMENT
Keywords:
extracorporeal circulation, abdominal complications, prognosis, correctionAbstract
Introduction. Abdominal catastrophes, occurring after cardiac surgery with cardiopulmonary bypass (CPB), take the leading place in the structure of possible complications. Aim. To analyze the frequency and structure of complications after cardiac surgery with cardiopulmonary bypass. Methods. Review of 37 studies between 1976 and 2004, covering over 172,000 cases and total of 8410 consecutive patients who underwent cardiac surgery with CPB at Research Institute for Complex Issues of cardiovascular disease from 2004– 2013 were analyzed. Results. The authors present a review of the epidemiology, risk and prognostic factors, specific management and preventive strategies for such complications. Ultrasonic imaging (contrast-enhanced ultrasound scanning) and radiological (selective mesenteric angiography) diagnostic tools, surface modifications and several types of cardiopulmonary bypass as well as pharmacological protection of the gastrointestinal are considered to be optimal for such category of patients. Conclusions. Advanced prevention of abdominal complications includes: choice of adequate techniques to conduct cardiopulmonary bypass (pulsatile flow, minimizing surface area of the extracorporeal circuit) and pharmacological methods to protect the gastrointestinal tract; however, the current work does not allow determining the proper time and place to use these preventive strategies.
References
Andersson B., Andersson R., Brandt J., Hoglund P., Algotsson L., Nilsson J. Gastrointestinal complications after cardiac surgery — improved risk stratification using a new scoring model. Interact Cardiovasc Thorac Surg 2010; 10: 366-370.
Danse E.M., Kartheuser A., Paterson H.M., Laterre P.F. Color Doppler sonography of small bowel wall changes in 21 consecutive cases of acute mesenteric ischemia. JBR-BTR 2009; 92 (4): 202-206.
Filsoufi F., Rahmanian P.B., Castillo J.G., Scurlock C., Legnani P.E., Adams D.H. Predictors and outcome of gastrointestinal complications in patients undergoing cardiac surgery. Ann Surg 2007; 246: 323-329.
Groesdonk H.V., Klingele M., Schlempp S., Bomberg H., Schmied W., Minko P., Schafers H.J. Risk factors for nonocclusive mesenteric ischemia after elective cardiac surgery. J Thorac Cardiovasc Surg 2013; 145:1603-1610.
Guohua D., Canhui L., Biao X., Hua J., Demin L., Haiwei W. Postoperative abdominal complications after cardiopulmonary bypass. Journal of Cardiothoracic Surgery 2012; 7:108-116.
Hamada T., Yamauchi M., Tanaka M., Hashimoto Y., Nakai K., Suenaga K. Prospective evaluation of contrast-enhanced ultrasonography with advanced dynamic flow for the diagnosis of intestinal ischaemia. The British Journal of Radiology 2007; 80 (956): 603-608.
Kazui T., Yamasaki M., Abe K., Watanabe S., Kawazoe K. Non-obstructive mesenteric ischemia: a potentially lethal complication after cardiovascular surgery: report of two cases. Ann Thorac Cardiovasc Surg 2012; 18: 56-60.
Lubner M., Demertzis J., Lee J.Y., Appleton C.M., Bhalla S., Menias C.O. CT evaluation of shock vis-cera: a pictorial review. Emergency Radiology 2008; 15 (1): 1-11.
Mazzei M.A., Mazzei F.G., Marrelli D., Imbriaco G., Guerrini S., Vindigni C., Civitelli S., Roviello F., Grassi R, Volterrani L. Computed tomographic evaluation of mesentery: diagnostic value in acute mesenteric ischemia. J Comput Assist Tomogr 2012; 36 (1): 1-7.
Pang P.Y., Sin Y.K., Lim CH, Su J.W., Chua Y.L. Outcome and survival analysis of intestinal ischemia following cardiac surgery. Interact Cardiovasc Thorac Surg 2012; 15: 215-218.
