Ann Thorac Surg 2005;80:2228
© 2005 The Society of Thoracic Surgeons
Original article: Cardiovascular
Invited commentary
Jan T. Christenson, MD, PhD
Department of Cardiovascular Surgery, University Hospital of Geneva, 24 rue Micheli-du-Crest, Geneva 14, CH-1211 Switzerland
(Email: jan.christenson{at}hcuge.ch).
Gastrointestinal complications are rare after cardiac surgery, but are associated with high mortality. Renal complications are more frequently observed but often transient in nature. Nonphysiologic hypoperfusion of the splanchnic bed during cardiopulmonary bypass is a possible causing factor. However, we demonstrated earlier that postoperative low cardiac output is a significant, independent predictor for the development of both complications. Preoperative, perioperative, and postoperative splanchnic hypoperfusion seems to be a crucial element. Furthermore we have shown that the use of preoperative intraaortic balloon counterpulsation (IABC) significantly reduces the postoperative risk for low cardiac output, and reduces gastrointestinal complications in high-risk patients undergoing myocardial revascularization.
The present prospective randomized study by Onorati and co-workers [1] is interesting and important. The authors have demonstrated that biochemical markers for splanchnic function remain the same or are even better when IABC therapy (automatic 80 bpm mode) is continued during aortic cross-clamp time as compared to IABC therapy stopping during cross-clamp time. Unfortunately, the authors studied only patients with relatively preserved preoperative left ventricular function (mean, 0.44). Perhaps in a group of patients with severely diminished left ventricular function (eg, <0.20), differences would have been more demonstrated. Even if it was not the aim of their study to determine whether or not continued IABC therapy during aortic cross clamp time provided physiologic pulsatile perfusion to the splanchnic bed, they have shown that continued IABC therapy during ischemic cardiac arrest does not cause harm and may be beneficial. This is a suggestion that should stimulate further research in this field.
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References
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- Onorati F, Cristodoro L, Mastroroberto P, et al. Should we discontinue intraaortic balloon during cardioplegic arrest? Splanchnic function results of a prospective randomized trial Ann Thorac Surg 2005;80:2221-2228.[Abstract/Free Full Text]
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