Acute mesenteric ischemia following cardiovascular surgery – A nested case-control study

• This study focusses on acute mesenteric ischemia following cardiovascular surgery.
• Preoperative versus perioperative risk factors were compared to predict mesenteric ischemia.
• Early postoperative parameters are superior to facilitate early diagnosis of mesenteric ischemia.
• Liver cirrhosis and emergency operation remain preoperative key factors.
• Serum lactate and use of catecholamines are most important perioperative indicators.

IntroductionAcute mesenteric ischemia is a rare but often fatal complication following cardiovascular surgery. Early suspicion may reduce overall mortality. This retrospective study aims to identify predictors and risk factors that may determine the onset and evolution of acute mesenteric ischemia.MethodsIn a retrospective case-control study, we compared co-morbidities and peri-operative risk factors of patients with or without mesenteric ischemia following cardiac surgery using univariate and logistic regression analyses.ResultsOf 9385 patients, 108 (1.15%) were diagnosed with acute mesenteric ischemia within two weeks after cardiac surgery. In-hospital mortality was 68% for this group. Patients with ischemia and controls were matched in regard to patient's age and type of surgical intervention and showed similar pre-operative parameters. Only liver cirrhosis (OR 13.3, CI95% 3.6–49.3), and emergency operation (OR 2.6, CI95% 1.3–5.2) remained independent pre-operative predictors for acute mesenteric ischemia in multivariate analysis. In contrast, early postoperative parameters revealed a higher correlation with the occurrence of mesenteric ischemia including the use of norepinephrine (OR 3.5 CI95% 1.6–7.8), epinephrine (OR 2.0, CI95% 1.1–3.7), and serum lactate levels >3 mmol/L (OR 2.9, CI95% 1.5–5.6). A set of key markers of regression analysis was evaluated in a ROC curve analysis. The area under curve was 0.835, which indicates moderate to good prognostic accuracy.ConclusionEarly identification of pre- and post-operative predictors including liver cirrhosis, emergency operation, serum lactate >3 mmol/L, and the use of norepinephrine and epinephrine may help facilitate early diagnosis of acute mesenteric ischemia following cardiac surgery, and thus may allow immediate adequate treatment, leading to a reduction in mortality rates.