Abstract
Abdominal complications are quite rare in open heart surgery (0.3–5%), but usually clinically associated
with worsening of patients postoperative condition and higher mortality rate. Main risk factors of abdominal
complications among patients after heart surgery with cardiopulmonary bypass are low cardiac output syndrome,
long cardiopulmonary bypass duration, significant blood loss, system inflammatory response and some others, associated with tissues and organs hypoperfusion. Abdominal complications in cardiosurgery
cases are also influenced by patients age (70 and older), preexisting gastrointestinal diseases and administration
of gastrointestinal mucosa damaging medication. Timely diagnostic, optimal preventive measures and
treatment algorithm (wide range of conservative therapy methods, including blood purification) of abdominal
complications allow for better results of cardiovascular surgery.
References
- Khan J.H., Lambert A.M., Habib J.H., Broce M.,
Emmett M.S., Davis E.A. Abdominal complications
after heart surgery. Ann. Thorac. Surg. 2006; 82:
1796–801. DOI: 10.1016/j.athoracsur.2006.05.093
- Dong G., Liu C., Xu B., Jing H., Li D., Wu H.
Postoperative abdominal complications after cardiopulmonary
bypass. J. Cardiothorac. Surg. 2012; 7: 108.
DOI: 10.1186/1749-8090-7-108
- Aithoussa M., Atmani N., Moutakiallah Y., Abdou A.,
Nya F., Bamous M. et al. Gastro-intestinal complications
after open heart surgery. Arch. Dig. Disord. 2017; 1
(2): 17–23.
- Eris C., Yavuz S., Yalcinkaya S., Gucu A., Toktas F.,
Yumun G. et al. Acute mesenteric ischemia after cardiac
surgery: an analysis of 52 patients. Sc. World J.
2013: 631534. DOI: 10.1155/2013/631534
- Belov Yu.V.,
Komarov R.N. Abdominal “catastrophes” in cardiac
surgery. Khirurgiya. Zhurnal imeni N.I. Pirogova
(Journal Surgery named after N.I. Pirogov). 2010; 4:
4–10 (in Russ.).
- Plotnikov G.P., Shukevich D.L., Grigoryev
E.V. Abdominal complication in cardiac surgery with
cardiopulmonary bypass. Kompleksnye Problemy
Serdechno-Sosudistykh Zabolevaniy (Complex Issues of
Cardiovascular Diseases). 2014; 1: 75–86 (in Russ.).
DOI: 10.17802/2306-1278-2014-1-75-86
- Popov D.A. Optimization of diagnostics,
antimicrobial therapy and prevention of infectious
complications in cardiac surgery. Dr. Med. Sc. Diss.
Moscow: 2014 (in Russ.).
- Chowdhury U.K., Airan R., Malhotra P., Reddy S.M.,
Singh R., Rizvi A. et al. Relationship of internal jugular
venous oxygen saturation and perfusion flow rate in
children and adults during normothermic and
hypothermic cardiopulmonary bypass. Hellenic J.
Cardiol. 2010; 51 (4): 310–22.
- Filsoufi F., Rahmanian P.B., Castillo J.G., Scurlock C.,
Legnani P.E., Adams D.H. Predictors and outcome of
gastrointestinal complications in patients undergoing
cardiac surgery. Ann. Surg. 2007; 246 (2): 323–9. DOI:
10.1097/SLA.0b013e3180603010
- Simić O., Strathausen S., Hess W., Ostermeyer J.
Incidence and prognosis of abdominal complications
after cardiopulmonary bypass. Cardiovasc. Surg. 1999;
7 (4): 419–24. DOI: 10.1016/S0967-2109(99)00008-3
- Grus T., Rohn V., Brlicová L., Lindner J., Lambert L.,
Daneš J. et al. Gastrointestinal complications after cardiac
surgery: eight years experience in a single center.
Acta Chir. Belg. 2014; 114 (5): 332–7.
- Allen S.J. Gastrointestinal complications and cardiac
surgery. JECT. 2014; 46: 142–9.
- Kazui T., Yamasaki M., Abe K., Watanabe S., Kawazoe
K. Non-obstructive mesenteric ischemia: a potentially
lethal complication after cardiovascular surgery:
report of two cases. Ann. Thorac. Cardiovasc. Surg.
2012; 18 (1): 56–60.
- Chung J.W., Ryu S.H., Jo J.H., Park J.Y., Lee S.,
Park S.W. et al. Clinical implications and risk factors
of acute pancreatitis after cardiac valve surgery. Yonsei.
Med. J. 2013; 54 (1): 154–9. DOI: 10.3349/
ymj.2013.54.1.154
- Iarustovskiıˇ M.B., Abramian M.V., Komardina E.V.,
Rep'eva E.V., Nazarova E.I., Krotenko N.P., Geptner
R.A. Extracorporeal methods of hematological correction
in patients with acute liver insufficiency after
cardiac surgery. Anesteziol. Reanimatol. 2014; 59 (5):
4–10.
- Daas M., Plevak D.J., Wijdicks E.F., Rakela J., Wiesner
R.H., Piepgras D.G. et al. Acute liver failure: results
of a 5-year clinical protocol. Liver Transpl. Surg. 1995;
1: 210–9. DOI: 10.1002/It.500010403
- Krisper P., Haditsch B., Stauber R., Jung A., Stadlbauer
V., Trauner M. et al. In vivo quantification of liver
dialysis: comparison of albumin dialysis and fractionated
plasma separation. J. Hepatol. 2005; 43 (3): 451–7.
DOI: 10.1016/j.jhep.2005.02.038
- Stadlbauer V., Krisper P., Beuers U., Haditsch B.,
Schneditz D., Jung A. et al. Removal of bile acids by
two different extracorporeal liver support systems in
acute-on-chronic liver failure. ASAIO J. 2007; 53 (2):
187–93. DOI: 10.1097/01.mat.0000249852.71634.6c
- Ryska O., Pantoflicek T., Laszikova E., Prazak J.,
Koblihova E., Ryska M. Artificial liver support system
reduces intracranial pressure more effectively than
bioartificial system: an experimental study. Int. J. Artif.
Organs. 2012; 35 (7): 503–10. DOI: 10.5301/ijao.
5000099
- Rifai K., Kribben A., Gerken G., Haag S., Herget-
Rosenthal S., Treichel U. et al. for the HELIOS Study
Group: extracorporeal liver support by fractionated
plasma separation and adsorption (Prometheus) in
patients with acute-on-chronic liver failure (HELIOS
study): a prospective randomized controlled multicenter
study. J. Hepatol. 2010; 52 (1): S3. DOI: 10.1016/
S0168-8278(10)60008-6
- Bockeria L.A., Yaroustovsky
M.B., Shipova E.A. Acute gastroduodenal
bleeding in cardiovascular surgery. Moscow; 2004
(in Russ.).
- Nevdah A.E., Mandel I.A. Tactics for
individual prophylaxis of gastroduodenal complications
in cardiac surgery. Vestnik RGMU (Bulletin of RSMU).
2013; Spec. Is. 1: 33 (in Russ.).
- Beznosov A.O., Podoksenov Yu.K., Prut D.A.,
Emel'yanova T.V., Shipulin V.M. Early detection, prevention
and treatment of gastrointestinal complications
in cardiosurgical patients. Sibirskij Medicinskij Zhurnal
(Irkutsk) (Siberian Medical Journal (Irkutsk)). 2010; 25
(4, Is. 1): 49–54 (in Russ.).
- Podoksenov Yu.K., Beznosov A.O.,
Emel'yanova T.V., Kiyko O.E., Shipulin V.M., Svirko
Yu.S. et al. Method of preoperative prediction of
ulcer complications from the gastrointestinal tract in
cardiosurgical patients. Patent RF № 2404712.
Izobreteniya. Poleznye Modeli (Invention. Useful
Models). 2010; 33 (in Russ.).
- Evseev M.A.,
Klishin I.M., Golovin R.A., Frolov I.A., Shapkin Yu.G.,
Kapralov S.V. Clinical course, prognosis and prevention
of acute postoperative erosive-ulcerative lesions
of the gastroduodenal zone in patients of older age
groups. Byulleten' Medicinskih Internet-konferencij
(Bulletin of Medical Internet Conferences). 2011; 1 (5):
17–23. (in Russ.). Available at: http://www.ssmj.ru/
system/files/201104_953-957.pdf (accessed 20 January
2018).
- Mandel I.A., Kiselev V.O., Shipulin V.M., Podoksenov
Yu.K., Nevdakh A.E. Tactics of antisecretory therapy
in the perioperative based on monitoring of gastric
acidity in cardiopulmonary bypass patients. Kompleksnye
Problemy Serdechno-Sosudistykh Zabolevaniy (Complex
Issues of Cardiovascular Diseases). 2012; 2: 45–51
(in Russ.).
- Vohra H.A., Farid S., Bahrami T., Gaer J.A. Predictors
of survival after gastrointestinal complications in bypass
grafting. Asian. Cardiovasc. Thorac. Ann. 2011; 19 (1):
27–32. DOI: 10.1177/0218492310394803
- Guler M., Yamak B., Erdogan M., Aydin U., Kul S.,
Asil R. et al. Risk factors for gastrointestinal complications
in patients undergoing coronary artery bypass graft
surgery. J. Cardiothorac. Vasc. Anesth. 2011; 25: 637–41.
DOI: 10.1053/j.jvca.2010.11.013
- Klinkenberg-Knol E.C., Nelis F., Dent J., Snel P.,
Mitchell B., Prichard P. et al. Long-Term Study Group.
Long-term omeprazole treatment in resistant gastroesophageal
reflux disease: efficacy, safety, and influence
on gastric mucosa. Gastroenterology. 2000; 118 (4):
661–9. DOI: 10.1016/S0016-5085(00)70135-1
- McDonald E.G., Milligan J., Frenette C., Lee T.C.
Continuous proton pump inhibitor therapy and the
associated risk of recurrent clostridium difficile
Infection. JAMA Intern. Med. 2015; 175 (5): 784–91.
DOI: 10.1001/jamainternmed.2015.42
- Isakov V.A. Safety of proton pump inhibitors for longterm
use. Klinicheskaya Farmakologiya i Terapiya
(Clinical Pharmacology and Therapy). 2004; 13 (1):
26–32 (in Russ.).
- Madanick R.D. Proton pump inhibitor side effects and
drug interactions: Much ado about nothing? Cleve. Clin.
J. Med. 2011; 78 (1): 39–49. DOI: 10.3949/ccjm.77a.
10087
About the authors
- Yaroustovsky Mikhail Borisovich, Dr. Med. Sc., Professor, Corresponding Member of Russian Academy of Sciences,Head of Department; orcid.org/0000-0002-1849-4745
-
Abramyan Marina Vladimirovna, Cand. Med. Sc., Senior Researcher; orcid.org/0000-0001-6200-7855
-
Nazarov Nikita Sergeevich, Cand. Med. Sc., Researcher; orcid.org/0000-0003-3278-7605
-
Komardina Ekaterina Viktorovna, Junior Researcher; orcid.org/0000-0002-4997-5218
-
Volkova Svetlana Stanislavovna, Physician; orcid.org/0000-0002-3575-1571
