P. Sastry et al. / Interactive CardioVascular and Thoracic Surgery

Author: Jamil Hajj-Chahine Department of Cardio-Thoracic surgery, University Hospital of Poitiers, Poitiers, France doi: 10.1093/icvts/ivu250 © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. I read with great interest the article by Sastry et al. [1] regarding the influence of intraoperative perfusion parameters on postcardiotomy mesenteric ischaemia. To avoid this life-threatening complication the authors recommend to increase the cardiopulmonary bypass flow rather than use high vasopressor dose in high-risk selected patients. Both the diagnosis and management of bowel ischaemia after cardiac operations have evolved from more invasive to less invasive strategies, paralleling the advent of sophisticated imaging tools and the improvement of novel therapies. Early detection of mesenteric ischaemia is correlated to better outcomes; for this reason some authors advocated the assessment of the gastric wall with continuous tonometry monitoring in selected patients with a high index of suspicion [2]. Like other studies dealing with this dreadful complication, there is an important issue not reported by the authors of the present study. Of note, postcardiotomy mesenteric

ischaemia is frequently unrecognized as a cause of mortality after cardiac surgery, as highlighted recently by Goodwin et al. [3]. Did patients of group B undergo a necropsy study to rule out bowel ischaemia as the primary fatal cause? It is my strong belief that every effort has to be made in order to avoid postoperative mesenteric ischaemia, which still carries a staggering mortality, by maintaining haemodynamic stability and avoiding bowel embolic events. Conflict of interest: none declared. References [1] Sastry P, Hardman G, Page A, Parker R, Goddard M, Large S et al. Mesenteric ischaemia following cardiac surgery: the influence of intraoperative perfusion parameters. Interact CardioVasc Thorac Surg 2014;19:419–25. [2] Mangi AA, Christison-Lagay ER, Torchiana DF, Warshaw AL, Berger DL. Gastrointestinal complications in patients undergoing heart operation: an analysis of 8709 consecutive cardiac surgical patients. Ann Surg 2005; 241:895–901. [3] Goodwin AT, Goddard M, Taylor GJ, Ritchie AJ. Clinical versus actual outcome in cardiac surgery: a post-mortem study. Eur J Cardiothorac Surg 2000;17: 747–51.

ORIGINAL ARTICLE

eComment. Underestimated occurrence of mesenteric ischaemia after cardiac surgery

425

eComment. Underestimated occurrence of mesenteric ischaemia after cardiac surgery.

eComment. Underestimated occurrence of mesenteric ischaemia after cardiac surgery. - PDF Download Free
33KB Sizes 0 Downloads 7 Views