Original article: cardiovascularDoes off-pump CABG reduce gastrointestinal complications?
Section snippets
Patients and methods
The Ethical Committee of the hospital approved the study. An informed consent was obtained from each patient. The study consisted of 1,146 cases that have undergone CABG in Florence Nightingale Hospital between January 1997 and September 2002. Cases with concomitant procedures such as valve repair, valve replacement, or resection of left ventricle aneurysm were not included in the study. Cases were divided into two groups: group 1 consisted of 546 CABG patients operated with off-pump technique.
Results
In group 1, 13 patients (2.4%) developed GI system complications postoperatively, whereas 14 patients (2.4%) developed GI complications postoperatively in group 2 (p = 0.963). The most commonly observed GI complication was GI bleeding (n = 4) in group 1 and intestinal ischemia (n = 5) in group 2. Mortality rate of the patients with GI complications was 38.5% in group 1 and 35.7% in group 2 (Table 1).
The risk profile for both groups was evaluated with the use of the EuroSCORE system. Mean risk
Comment
The etiology and risk factors contributing to GI complications after coronary artery surgery have been defined extensively [8]. The combined stress of anesthesia, surgery, anticoagulation, hypothermia, and cardiopulmonary bypass triggers a hormonal stress response and a massive defense reaction compounded by hemodilution and nonpulsatile flow, which as a whole can lead to organ damage. Like all other organ systems, the GI system is exposed to vasoactive substances and microembolism during CPB,
References (33)
- et al.
Postoperative abdominal complications in cardiopulmonary bypass patientsa case-controlled study
Ann Thorac Surg
(1995) - et al.
Off-pump bypass graft operation significantly reduces oxidative stress and inflammation
Ann Thorac Surg
(2000) - et al.
Gastrointestinal complications after coronary artery bypass grafting
J Thorac Cardiovasc Surg
(1994) The role of the gut in the development of multiple organ dysfunction in cardiothoracic patients
Ann Thorac Surg
(1993)- et al.
Mesenteric dysfunction after cardiopulmonary bypassrole of complement C5a
Ann Thorac Surg
(2000) - et al.
Gut mucosal ischemia during normothermic cardiopulmonary bypass results from blood flow redistribution and increased oxygen demand
J Thorac Cardiovasc Surg
(1995) - et al.
Off-pump coronary artery bypass is associated with improved risk-adjusted outcomes
Ann Thorac Surg
(2001) - et al.
Off-pump coronary artery bypass graftingnot a flash in the pan
Ann Thorac Surg
(2003) - et al.
Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2)a pooled analysis of two randomized controlled trials
Lancet
(2002) - et al.
Effect of cardiopulmonary bypass on gastrointestinal perfusion and function
Ann Thorac Surg
(1994)
Regional perfusion abnormalities with phenylephrine during normothermic bypass
Ann Thorac Surg
Intraabdominal complications after cardiopulmonary bypass
Ann Thorac Surg
Trends in coronary artery bypass surgery resultsa recent, 9-year study
Ann Thorac Surg
Postoperative gastrointestinal complications after lung volume reduction operations
Ann Thorac Surg
The effect of clopidogrel in combination with aspirin when given before coronary artery bypass grafting
J Am Coll Cardiol
Acute gastrointestinal complications after open heart surgery
Asian Cardiovasc Thorac Ann
Cited by (48)
Development and validation of a postoperative bleeding complications prediction model in infective endocarditis
2024, International Journal of CardiologyGastrointestinal Complications After Cardiac Surgery: A Nationwide Population-Based Analysis of Morbidity and Mortality Predictors
2017, Journal of Cardiothoracic and Vascular AnesthesiaAcute mesenteric ischemia following cardiovascular surgery - A nested case-control study
2016, International Journal of SurgeryPerioperative complications of cardiac surgery and postoperative care
2014, Critical Care ClinicsCitation Excerpt :Studies have not been consistent regarding the threshold at which certain variables lead to increased risk (age, creatinine level in chronic renal insufficiency). Both CPB and prolonged CPB times have been associated with an increased risk of GI complications, but not consistently.52,57 Despite this potential association, the use of off-pump cardiac surgery has not consistently led to a decrease in the incidence of complications.57–59
Acute bowel ischemia after heart operations
2014, Annals of Thoracic SurgeryThe Effect of Postoperative Gastrointestinal Complications in Patients Undergoing Coronary Artery Bypass Surgery
2010, Annals of Thoracic Surgery