TOWARDS A BETTER COMPREHENSION OF ACUTE MESENTERIC ISCHEMIA AFTER
CARDIAC SURGERY. AN ANALYSIS OF 33 PATIENTS.
Background. Acute mesenteric ischemia (AMI) after cardiac surgery is a
rare but serious complication associated to high mortality. The time of
onset is the key point to correctly evaluate the clinical scenarios.
Methods. Data from adult patients who underwent laparotomy for AMI after
elective or urgent cardiac surgery were reviewed (January 2005 -
December 2019) to report their anatomoclinical features in relationship
to time of onset. Early events (within 48 hours) were allocated to Group
1, whereas late onsets were allocated to Group 2. Results. The incidence
of risk factors for non occlusive mesenteric ischemia was higher in
Group 1 (chronic renal failure 80% vs 38.8%, P <0.05, use of
inotropes 60% vs 5.5%, P <0.01, early oligo-anuria requiring
CRRT 80% vs 16.6%, P <0.01, prolonged ventilation 46.6% vs
5.5%, P <0.05), where a significative occurrence of
postoperative de novo atrial fibrillation was noted in Group 2 (55% vs
5.5%, P <0.01). The number of patients who required bowel
resection was proportionally higher in the Group 2 Conclusions. Two well
distincted categories of AMI after cardiac surgery can be classified.
The first consists of patients with well-known risk factors developing
ischemia as a result of severe visceral hypoperfusion The second
consists of patients with low comorbidity who experience late AMI as a
consequence of“trigger events”, mainly de novo atrial fibrillation.
This classification may be useful to better alert the medical staff to
the possibility of bowel ischemia at any time after cardiac surgery,
promoting early diagnosis and treatment.