Mangi AA et al. (2005) Gastrointestinal complications in patients undergoing heart operation. An analysis of 8709 consecutive cardiac surgical patients. Ann Surg 241: 895–904

Though gastrointestinal complications in patients who have undergone heart operations are rare, they pose a significant mortality and morbidity risk. Mangi and colleagues therefore investigated the variables that could cause gastrointestinal complications after cardiac surgery, to enable strategies for alleviating this risk to be identified.

Out of 8,709 patients who underwent a heart operation at the Massachusetts General Hospital between 1997 and 2003, 46 subsequently suffered from gastrointestinal complications and were therefore included in this study. The authors identified 89 preoperative, intraoperative and postoperative variables of gastrointestinal complications, which they compared against a control group of 250 randomly selected patients.

The results demonstrated the most frequent gastrointestinal complication after cardiac surgery to be mesenteric ischemia, which was suspected or documented in 31 out of the 46 patients, proving fatal in 68% of these cases. Preoperative predictors of mesenteric ischemia include atheroembolization, heparin-induced thrombocytopenia and hypoperfusion. Other gastrointestinal complications included diverticulitis, pancreatitis, peptic ulcer disease and cholecystitis. Significant predictors of death from a gastrointestinal complication after cardiac surgery included New York Heart Association class II and IV heart failure, smoking, chronic obstructive pulmonary disease and syncope at time of presentation.

The authors conclude that early recognition is important for survival from mesenteric ischemia as this complication often occurs within hours after surgery. They suggest that this could be achieved by fast-track extubation pathways or minimum sedation. Ultimately, techniques to reduce the occurrence of mesenteric ischemia after heart surgery will be necessary to reduce overall mortality.