Comparison of intestinal ischemia after on-pump versus off-pump coronary artery bypass grafting surgery
Comparison of intestinal ischemia after on-pump versus off-pump coronary artery bypass grafting surgery
Background/aim: Acute mesenteric ischemia (AMI), one of the gastrointestinal system complications, which occurs following cardiacsurgery, is challenged in the literature with a diminished incidence of AMI by heart surgery without cardiopulmonary bypass (CPB)or with pulsatile CPB. This study aims to compare the incidence and mortality rate of mesenteric ischemia in a series of consecutivepatients undergoing coronary artery bypass grafting (CABG) through on-pump and off-pump techniques.Materials and methods: This study included patients who underwent CABG between 1 January 2010 and 31 June 2016. All patientswere divided into two groups: Group 1 comprised 6396 CABG patients operated on with the off-pump technique. Group 2 included1210 patients who received CABG with the on-pump technique. Preoperative data were collected on the studied variables. Postoperativedata included the development of intestinal ischemia and in-hospital mortality.Results: Of 7606 consecutive CABG patients, a total of 31 (0.4%) developed intestinal ischemia. The incidence of postoperativemesenteric ischemia was 0.28% in Group 1 and 1.07% in Group 2 (P = 0.000). The survival rates after AMI were 61.1% in Group 1 (offpump) and 7.7% in Group 2 (on-pump) (P = 0.003). Time from the first occurrence of nonspecific GI complaints to laparotomy wassimilar in the off-pump and on-pump groups and had no effect on mortality.Conclusions: With regard to the incidence of mesenteric ischemia and survival after laparotomy, off-pump CABG patients revealedsignificant improvement compared with those operated on with the on-pump technique.
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- 1. Tofukuji M, Stahl GL, Metais C, Tomita M, Agah A, Bianchi
C, Fink MP, Sellke FW. Mesenteric dysfunction after
cardiopulmonary bypass: role of complement C5a. Ann Thorac
Surg 2000; 69: 799-807.
- 2. Mangi AA, Christison-Lagay ER, Torchiana DF, Warshaw AL,
Berger DL. Gastrointestinal complications in patients undergoing
heart operation: an analysis of 8709 consecutive cardiac surgical
patients. Ann Surg 2005; 241: 895-901.
- 3. Tao W, Zwischenberger JB, Nguyen TT, Vertrees RA, McDaniel
LB, Nutt LK, Herndon DN, Kramer GC. Gut mucosal ischemia
during normothermic cardiopulmonary bypass results from
blood flow redistribution and increased. J Thorac Cardiovasc
Surg 1995; 110: 819-828.
- 4. Matata BM, Sosnowski AW, Galinanes M. Off-pump bypass
graft operation significantly reduces oxidative stress and
inflammation. Ann Thorac Surg 2000; 69: 785-791.
- 5. Schulze C, Conrad N, Schütz A, Egi K, Reichenspurner
H, Reichart B, Wildhirt SM. Reduced expression of systemic
proinflammatory cytokines after off-pump versus conventional
coronary artery bypass grafting. Thorac Cardiovasc Surg 2000;
48: 364-369.
- 6. Yap KH, Chua KC, Lim SL, Sin YK. Is it possible to predict the
risk of ischaemic bowel after cardiac surgery? Interact Cardiov
Th 2014; 19: 494-498.
- 7. Benedetto U, Caputo M, Mariscalco G, Gaudino M, Chivasso
P, Bryan A, Bryan A, Angelini GD. Impact of multiple arterial
grafts in off-pump and on-pump coronary artery bypass surgery.
J Thorac Cardiovasc Surg 2017; 153: 300-309.
- 8. Fudulu D, Benedetto U, Pecchinenda GG, Chivasso P, Bruno VD,
Rapetto F, Bryan A, Angelini GD. Current outcomes of off-pump
versus on-pump coronary artery bypass grafting: evidence from
randomized controlled trials. J Thorac Dis 2016; 8: 758-771.
- 9. Musleh GS, Patel NC, Grayson AD, Pullan DM, Keenan DJ, Fabri
BM, Hasan R. Off-pump coronary artery bypass surgery does not
reduce gastrointestinal complications. Eur J Cardiothorac Surg
2003; 23: 170-174.
- 10. Sanisoglu I, Guden M, Bayramoglu Z, Sagbas E, Dibekoglu
C, Sanisoglu SY, Akpinar B. Does off-pump CABG reduce
gastrointestinal complications? Ann Thorac Surg 2004; 77: 619-
625.
- 11. Eris C, Yavuz S, Yalcinkaya S, Gucu A, Toktas F, Yumun G,
Erdolu B, Ozyazıcıoglu A. Acute mesenteric ischemia after
cardiac surgery: an analysis of 52 patients. Scientific World
Journal 2013; 2013: 631534.
- 12. Croome KP, Kiaii B, Fox S, Quantz M, McKenzie N, Novick
RJ. Comparison of gastrointestinal complications in onpump versus off-pump coronary artery bypass grafting. Can J
Surg 2009; 52: 125-128.
- 13. Mastoraki A, Mastoraki S, Tziava E, Touloumi S, Krinos
N, Danias N, Lazaris A, Arkadopoulos N. Mesenteric
ischemia: pathogenesis and challenging diagnostic and
therapeutic modalities. World J Gastrointest Pathophysiol 2016;
15: 125-130.
- 14. Chaudhuri N, James J, Sheikh A, Grayson AD, Fabri BM.
Intestinal ischaemia following cardiac surgery: a multivariate
risk model. Eur J Cardio-Thorac 2006; 29: 971-977.
- 15. Schoots IG, Koffeman GI, Legemate DA, Levi M, van Gulik
TM. Systematic review of survival after acute mesenteric
ischaemia according to disease aetiology. Br J Surg 2004; 91:
17-27.
- 16. Abboud B, Daher R, Sleilaty G, Madi-Jebara S, El Asmar B,
Achouch R, Jebara V. Is prompt exploratory laparotomy the
best attitude for mesenteric ischemia after cardiac surgery?
Interact Cardiov Th 2008; 7: 1079-1083.
- 17. Lorusso R, Mariscalco G, Vizzardi E, Bonadei I, Renzulli A,
Gelsomino S. Acute bowel ischemia after heart operations.
Ann Thorac Surg 2014; 97: 2219-2227.
- 18. Sastry P, Hardman G, Page A, Parker R, Goddard M, Large S,
Jenkins DP. Mesenteric ischaemia following cardiac surgery:
the influence of intraoperative perfusion parameters. Interact
Cardiov Th 2014; 19: 419-424.
- 19. Ghosh S, Roberts N, Firmin RK, Jameson J, Spyt TJ. Risk
factors for intestinal ischaemia in cardiac surgical patients. Eur
J Cardiothorac Surg 2002; 21: 411-416.
- 20. D’Ancona G, Baillot R, Poirer B, Dagenais F, Saez de Ibarra JI,
Bauset R, Mathieu P, Doyle D. Determinants of gastrointestinal
complications in cardiac surgery. Tex Heart Inst J 2003; 30:
280-285.