Incidence, survival and determinants of mortality following mesenteric angiography and continuous intra-arterial prostaglandin E1perfusion for non-occlusive mesenterial ischaemia in cardiac surgery

Background: Non-occlusive mesenteric ischaemia (NOMI) is a rare but severe complication. Early recognition of NOMI is difficult due to its aspecific symptoms and the lack of specific laboratory parameters. Prevention, diagnosis and optimal therapy are under examinations. Methods: Our aim was to evaluate the incidence of NOMI, to analyse results of treatment and to identify variables associated with mortality. Hospital records and clinical data of patients treated for NOMI during the last 12 years were reviewed. Clinical outcomes and factors influencing mortality were studied. Statistical analysis was performed to determine the significance of risk factors on mortality with Fisher exact test or χ2 test in categorial variables. Wilcoxon rank test was used to test the continous variables. Results: Between 7/2001and 6/2013 NOMI developed in 64 cases (0.5%). Mean age of patients was 67.9±6.9 year. First symptoms occured 2.7±2 days after the operation. Mesenteric artery angiography was performed in 59 patients(92.8%). After confirmation of mesenteric vasospasm, a continuous infusion of 2.4 µg/h of prostagalandin E1(PGE1) was administered in the superior mesenteric artery. The 30-day mortality of NOMI after PGE1 treatment was 66. Logistic regression analysis of risk factors revealed preoperative NYHA stadium (P<0.02), presence of internal carotid artery stenosis (P<0.05), prolonged CPB and aortic cross clamp time P<0.01), postoperative arrhytmias (P<0.05), reoperation (P<0.03), use of arterenol and/or IABP ( P<0.05), serum lactate level (P<0.01), length of ventillation (P<0.001 and number of transfused red blood cell units (P<0.05) were independent predictors of mortality. Conclusions: Mesenteric ischaemia in cardiac surgery remains a devastating complication. A high index of suspicion with promt diagnostic evaluation may reduce the delay prior to intervention. Early mesenteric angiography and intraarterial PGE1 infusion seems to be useful to improve survival.