Predictors for negative clinical outcome in acute mesenteric ischemia after on-pump cardiac surgery: a retrospective observational trial

Abstract

INTRODUCTION: Acute mesenteric ischemia (AMI) is one of the most dangerous complications of cardiac surgery using cardiopulmonary bypass (CPB). Several factors may contribute to the development of AMI, such as: age over 70 years, prolonged CBP, postoperative heart failure, cardiogenic shock, mechanical circulatory support and others. The mortality rate in AMI reaches 85 %. OBJECTIVE: To identify predictors of a negative clinical outcome in the development of acute mesenteric ischemia in patients after on-pump cardiac surgery. MATERIALS AND METHODS: A single-center retrospective observational cohort study included 53 patients in the intensive care unit who developed AMI after cardiac surgery performed using CPB. All patients with AMI included in the study were divided into two groups — survivors (n = 31) and non- survivors (n = 22) to identify predictors of negative clinical outcome. RESULTS: At the preoperative stage, the left ventricular ejection fraction (LVEF) was impaired in both groups, but in non-survived patients was significantly lower: 34.6 (25.4–52.4) in survivors and 28.7 (25.2–42.7) in non-survivors (p = 0.05). 12 hours after the surgery, the cardiac index (CI) (p = 0.01) and the index of left ventricular work (ILVW) were significantly (p = 0.03) lower in non-survivors. The average duration of CPB was 124 minutes (95–142) in survivors and 164 minutes in non-survivors (145–176) (p = 0.02). Also, 72.7 % of n0n-survivers received high doses of adrenomimetics in the postoperative period, in survivors — 41.9 % (p = 0.03). The rate of long-term mechanical respiratory support usage in non-survivors reached 86.3 %, in survivors — 35.4 % (p = 0.003). CONCLUSIONS: The key predictors of a negative outcome of OMI in cardiac surgery patients are: prolonged use of CBP, low CI, LVWI before and after surgery, high doses of adrenomimetics, prolonged mechanical respiratory support, as well as high concentrations of blood lactate 12 hours after the end of the surgery.