Comparison of intestinal ischemia after on-pump versus off-pump coronary artery bypass grafting surgery

Abstract

Background/aim: Acute mesenteric ischemia (AMI), one of the gastrointestinal system complications, which occurs following cardiacsurgery, is challenged in the literature with a diminished incidence of AMI by heart surgery without cardiopulmonary bypass (CPB)or with pulsatile CPB. This study aims to compare the incidence and mortality rate of mesenteric ischemia in a series of consecutivepatients undergoing coronary artery bypass grafting (CABG) through on-pump and off-pump techniques.Materials and methods: This study included patients who underwent CABG between 1 January 2010 and 31 June 2016. All patientswere divided into two groups: Group 1 comprised 6396 CABG patients operated on with the off-pump technique. Group 2 included1210 patients who received CABG with the on-pump technique. Preoperative data were collected on the studied variables. Postoperativedata included the development of intestinal ischemia and in-hospital mortality.Results: Of 7606 consecutive CABG patients, a total of 31 (0.4%) developed intestinal ischemia. The incidence of postoperativemesenteric ischemia was 0.28% in Group 1 and 1.07% in Group 2 (P = 0.000). The survival rates after AMI were 61.1% in Group 1 (offpump) and 7.7% in Group 2 (on-pump) (P = 0.003). Time from the first occurrence of nonspecific GI complaints to laparotomy wassimilar in the off-pump and on-pump groups and had no effect on mortality.Conclusions: With regard to the incidence of mesenteric ischemia and survival after laparotomy, off-pump CABG patients revealedsignificant improvement compared with those operated on with the on-pump technique.