In a comprehensive literature review, researchers addressed the impact cardiac surgery has on gastrointestinal outcomes.
Despite being a relatively rare occurrence, researchers found that cardiac surgery can lead to gastrointestinal complications with high mortality, specifically paralytic ileus, gastrointestinal (GI) bleeding, bowel ischemia, and liver failure. Patients undergoing cardiac surgery are typically intubated and may find it more difficult to express pain and clinical symptoms, highlighting that early detection and aggressive intervention are key to treating GI complications, according to data from Trauma Surgery & Acute Care Open.1
Previous research has shown that cardiology and digestive health have a complex relationship with each other. “Currently, scientific evidence proves the existence of a 2-way relationship between the gut microbiota and [cardiovascular disease]. The mechanisms involved in this relationship are multiple and extremely complex because they concern immune regulation, inflammatory response, [GI] barrier integrity, metabolic pathways, and much more,” wrote authors of a previous study published in the International Journal of Molecular Sciences.2
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While it is known that cardiovascular complications can impact GI outcomes and the gut microbiota, researchers determined how cardiac surgery impacts GI complications. To address this association, they conducted a literary review to update a previous comprehensive review of the topic from 2010.
A total of 40 articles were included in the review, leaving off animal studies, older review articles, and articles unrelated to post-operative GI complications in cardiac surgery.
“Seven major retrospective studies assessed the frequency and risk factors of GI complications following a cardiac operation. The most commonly cited complications were paralytic ileus, upper GI bleeding, mesenteric ischemia, acute cholecystitis, and acute pancreatitis. Mortality of GI complications across the studies above ranged from 10% to 38%,” wrote the authors.1
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Aside from common GI complications spurred on by cardiac surgery, the complication that experienced the highest mortality at nearly 100% was mesenteric ischemia, which is when blood flow to the small intestine is blocked or narrowed.3
Moving back to the more common GI complications most prominent in patients undergoing cardiac surgery, GI bleeding affected just under 70% of patients who experienced post-operative GI complications. Upper GI bleeding specifically, opposed to lower GI bleeding, had what the authors considered as “high mortality” at 47.6%. Lower GI bleeding, on the other hand, was less severe for patients included in the study. “Lower GI bleed incidence ranged between 0.02% and 0.34%, forming up to 12.3% of GI complications. Mortality was 10% in one series,” they continued.1
As previously mentioned, mesenteric ischemia holds the highest mortality rate for any type of bowel ischemia or GI complication overall. The occurrence of bowel ischemia in general also holds a very high mortality compared with other complications. According to the researchers’ findings, overall mortality for bowel ischemia ranged from 57.5% to 100%.
From biomarkers to serum markers, researchers have worked continuously to best detect bowel ischemia in patients as early as possible. Researchers have also considered a scoring system to assist in early recognition of the condition. However, despite efforts to ameliorate mortality in relation to bowel ischemia, not much positive movement has been reported.
“Unfortunately, there has not been much of a positive change in terms of survival of post-operative bowel ischemia in the past decade. Given very high mortality, it is paramount to maintain a low threshold for further diagnostic evaluation when bowel ischemia is suspected,” they continued.1
Finally, authors of the study ended their review by touching on liver failure and its relationship with cardiac surgery. Despite being a less-common GI complication explored in the review (12%), liver failure carried a mortality of up to 50% and 90% when coupled with another organ failing.
“GI complications after cardiac surgery remain a rare entity that unfortunately carries high mortality. Among the most lethal ones are mesenteric ischemia, GI bleed, and liver failure. Cardiac surgery patients possess specific challenge as they often remain intubated in the early post-operative period, cannot verbalize their complains, and may not develop the usual clinical symptoms. Early diagnosis and appropriate management are mandatory and may positively affect the outcomes,” concluded authors of the study.1
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