Acute mesenteric ischemia after cardiac surgery. Role of the abdominal compartment syndrome treatment.

Abstract

BACKGROUND: The management of abdominal compartment syndrome (ACS) has been included as a standard of care in our therapeutic algorithm after diagnosis of acute mesentheric ischemia (AMI), following cardiac surgery. This report is an updated review of our results compared to previous experience.

MATERIALS AND METHODS: A retrospective, observational, cohort study on a series of 26 patients (20 males, 6 females, mean age 75.2 years, min 64, max 83) who developed AMI, out of 7.719 patients undergoing cardiac operations (january 2005 – December 2014). The initial treatment consisted of laparotomy with abdominal decompression and temporary abdominal closure, performing visceral resections just in case of gangrenous tracts and providing for a “secondlook” during the variable period of resuscitation and vacuum assisted dressing.

RESULTS: A non-occlusive mesentheric ischemia with diffuse visceral underperfusion was confirmed in every case. Temporary abdominal closure was applied to treat ACS in every case, 13 patients required associated resection of gangrenous tracts (50%). Seventeen patients died following first operation as a consequence of multiple organ failure (65.4%). Nine patients survived (34.6%) and underwent re-establishment of intestinal continuity and definitive closure of abdominal wall within 30 DAYS.

DISCUSSION AND CONCLUSIONS: AMI occuring after cardiac surgery is associated with an increase of intra-abdominal pressure and subsequent ACS. Basing on this case series, an early ACS treatment using open abdomen techniques may be results in a better outcome of critically injured cardiac patients. These results compared favourably with literature experiences (mortality rate > 85%).