Incidence and Outcome of Gastrointestinal Complications After Cardiac Surgery—A Ten-Year Experience of a Single Australian Centre

Abstract

[2] Lus F, Hagl C, Haverich A, Pichlmaier M. Elephant trunk procedure 27 years after Borst: what remains and what is new? European Journal of Cardio-thoracic Surgery 2011;40:1–12. doi:10.1016/j.hlc.2011.08.064 2011 Poster Presentation/Panel 26 Incidence and Outcome of Gastrointestinal Complications After Cardiac Surgery—A Ten-Year Experience of a Single Australian Centre Fabiano Viana ∗, Yi Chen, Aubrey Almeida, Andrew Cochrane, Adrian Pick, Randall Moshinsky, Cliff Choong, Jacob Goldstein, Julian Smith Monash Medical Centre, Southern Health, Melbourne, Australia Introduction: Gastrointestinal (GI) complications after cardiac surgery are uncommon, but are associated with highmortality and prolonged hospital stay. The incidence, patient profile and outcome of GI complications after cardiac surgery in Australia have not been previously reported. Methods: We analysed a single-centre prospectively collected database containing all adult cardiac surgery procedures performed from July 2001 to March 2011 at Monash Medical Centre and Jessie McPherson’s Private Hospital. Patients with post-operative GI complications Conclusions: GI complications after cardiac surgery remain an uncommon but dreadful complication associated with high mortality. It is hoped that our findings will prompt a high degree of clinical vigilance and early diagnosis especially in selected high risk patients. Further studies aiming to identify independent predictors for GI complications after cardiac surgery in our population would be warranted. doi:10.1016/j.hlc.2011.08.065 2011 Poster Presentation/Panel 27 A Remote Ischaemic Preconditioning Protocol Does not Alter the Function of Human Right Atrium In Vitro Yasmin Whately 1,∗, Peter Molenaar 1, Katherine Gillette 2, Bronwyn Pearse1, John Fraser 1 1 Critical Care Research Group, Prince Charles Hospital, University of Queensland, Brisbane, Australia 2 Queensland University of Technology, Brisbane, Australia Introduction:Remote ischaemicpreconditioning (RIPC) is the phenomenon in which non-lethal ischaemia and reperfusion of one organ or tissue confers resistance to subsequent ischaemia reperfusion injury in a remote organ. Early clinical trials have shownpotential benefits in humans undergoing cardiac surgery.We aimed to investigate the effects of an RIPC protocol on human right atrial were compared with patients without GI complications who were operated in the same period. Statistical analyses were carried out in SPSS using t-test and chi-square test where appropriate. A p-value≤ 0.05 is considered statistically significant. Results: The incidence of GI complications was 1.1% (60 out of 5393 patients) with an overall 30-day mortality of 25.8%. Themost common complications involved GI bleeding, perforatedduodenal ulcer andbowel ischaemia. Preoperatively, patients that had GI complications were significantly older (69 vs 64 years), had higher creatinine levels (155 vs 108 mol/l) and higher incidence of chronic lung disease (21 vs 11%), anticoagulation therapy (24 vs 11%), shock (9 vs 2%) and inotrope usage (6 vs 2%). Emergency, combined CABG and valve, aortic dissection and anti-arrhythmic surgery cases occurred more frequently in theGI complication group (14 vs 5%, 21 vs 10%, 11 vs 3%, 14 vs 2%, respectively). Aortic cross-clamp and CPB times were significantly higher in the GI complication group (88 vs 77, 137 vs 105min). Regarding outcomes, the GI complication group had higher incidence of return to theatre (42 vs 5%), renal failure (36 vs 6%),myocardial infarction (8 vs 0.6%), cardiogenic shock (9 vs 0.5%), stroke (12 vs 1%), prolonged ventilation (51 vs 12%), septicaemia (16 vs 1%) and multi-organ failure (24 vs 0.5%). In the GI complication group, those who died had a higher CPB time (197 vs 116min) and higher incidence of emergency cases (24 vs 10%), return to theatre (65 vs 35%), renal failure (70 vs 24%), cardiogenic shock (18 vs 6%), stroke (35 vs 4%), prolonged ventilation (70 vs 45%) and septicaemia (29 vs 12%) (p≤ 0.05 for all comparisons). function in vitro. Methods: Samples of right atrial appendage were obtained from 10 patients undergoing coronary artery bypass grafting. Patients were randomised to receive the RIPC protocol (four cycles of inflation of a blood pressure cuff placed on the upper limb inflated to 200mmHg for 5min followedby5minof reperfusion) or shamplacement of the cuff (control). Immediately prior to termination of cardiopulmonary bypass, the right atrial appendage was removed. Trabeculae were isolated, set up on electrode tissue blocks and electrically stimulated. Force–frequency relationships (6–120 bpm)and concentration–effect curves for 5HTwere established followed bymaximal concentrations of isoprenaline (200mM) and calcium (7mM) were established. Serial troponinswere obtained preandpostoperatively. Results: The force–frequency relationships for both groupswerepositive.Therewerenodifferences inpotency to inotropic (−logEC50 RIPC protocol 6.88± 0.08, n= 15 trabeculae/5 hearts; control 6.69± 0.16, n= 12 trabeculae/5 hearts; P= 0.27 or maximal effects (P= 0.17) of 5HT. Peak troponins were not significantly different (P= 0.86). Conclusions:Our results show that RIPC does not alter the function of human right atrium in vitro. doi:10.1016/j.hlc.2011.08.066