colonic ischemia after CPB

Q: Name a few risk factors that may induce colonic ischemia after cardiopulmonary bypass?

Answer:

Although colonic ischemia is rare (0.2 percent) after cardiopulmonary bypass, if it occurs, it is usually fatal (85 percent). A few risk factors are:

• old age
• end-stage renal disease (ESRD)
• valve surgery
• emergency bypass surgery
• low postoperative cardiac output 
• Long bypass times
• an intra-aortic balloon pump 

The underlying etiology is the low flow state of bypass perfusion and the exposure of the patient's blood to foreign surfaces, which leads to hypercoagulability, microemboli, alterations in cells and proteins, the release of vasoactive substances, and activation of the complement cascade. 

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References:

1. Fitzgerald T, Kim D, Karakozis S, et al. Visceral ischemia after cardiopulmonary bypass. Am Surg 2000; 66:623.

2. Allen KB, Salam AA, Lumsden AB. Acute mesenteric ischemia after cardiopulmonary bypass. J Vasc Surg 1992; 16:391.

3. Zacharias A, Schwann TA, Parenteau GL, et al. Predictors of gastrointestinal complications in cardiac surgery. Tex Heart Inst J 2000; 27:93.