Abstract

Background/aim Acute mesenteric ischemia (AMI), one of the gastrointestinal system complications, which occurs following cardiac surgery, 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 consecutive patients 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 patients were divided into two groups: Group 1 comprised 6396 CABG patients operated on with the off-pump technique. Group 2 included 1210 patients who received CABG with the on-pump technique. Preoperative data were collected on the studied variables. Postoperative data 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 postoperative mesenteric 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 (off-pump) and 7.7% in Group 2 (on-pump) (P = 0.003). Time from the first occurrence of nonspecific GI complaints to laparotomy was similar 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 revealed significant improvement compared with those operated on with the on-pump technique.

Highlights

  • Acute mesenteric ischemia (AMI) is a rare but highly fatal complication of coronary artery bypass grafting (CABG)

  • This study aims to compare the incidence and mortality rate of mesenteric ischemia in a series of consecutive patients undergoing coronary artery bypass grafting (CABG) through on-pump and off-pump techniques

  • The incidence of postoperative mesenteric ischemia was 0.28% in Group 1 and 1.07% in Group 2 (P = 0.000)

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Summary

Introduction

Acute mesenteric ischemia (AMI) is a rare but highly fatal complication of coronary artery bypass grafting (CABG). It has been attributed to perioperative low cardiac output and visceral hypoperfusion resulting in mucosal ischemia and necrosis. It has been speculated that, despite the normal indices of global perfusion, cardiopulmonary bypass (CPB) can be hazardous to mucosal ischemia by reducing the blood flow and stimulating the systemic inflammatory response (SIR), secondary to mesenteric sequestration of neutrophils [1,2,3]. Off-pump CABG, in contrast, has been reported to reduce SIR, allowing an environment that is physiologically more favorable for the organ systems [4]. The off-pump technique reduces the need for systemic vasoconstrictors or inotropic requirements during cardiac surgery [5].

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