title: Virchow's triad and intestinal ischemia post cardiac surgery.
abstract: BACKGROUND
  Intestinal ischemia is associated with a very high mortality rate. We combined the principles of Virchow's triad to produce preoperative and postoperative models for the development of intestinal ischemia.
  
  
  METHODS
  A single institutional study was undertaken involving 18,325 consecutive patients from April 1997 to March 2012. Univariate and multivariate analysis was performed.
  
  
  RESULTS
  Mortality was 87% in 91 patients who developed bowel ischemia. Multivariate logistic regression demonstrated that age, peripheral vascular disease, intraaortic balloon pump support, female sex, and preexisting renal failure were significant determinates of intestinal ischemia preoperatively. Logistic regression demonstrated that age, peripheral vascular disease, creatine kinase-MB level, reoperation for bleeding, and blood product usage were significant determinates of intestinal ischemia postoperatively.
  
  
  CONCLUSIONS
  Potentially remedial causes of intestinal ischemia include blood product usage, reoperation for bleeding, and creatine kinase-MB release. Age, female sex, peripheral vascular disease, intraaortic balloon pump usage, and preexisting renal failure are fixed risk factors. Despite the continuing trend of reduced blood product usage in the field of cardiac surgery, the increase in patients' risk factors will mean that incidences of intestinal ischemia may increase in the future.
authors.affiliation: Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Warwick
authors.affiliation: Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Mediratta
authors.affiliation: Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: John
authors.initials: J
authors.lastname: Chalmers
authors.affiliation: Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: James
authors.initials: J
authors.lastname: McShane
authors.affiliation: Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Shaw
authors.affiliation: Liverpool Heart and Chest Hospital, Liverpool, UK mike.Poullis@lhch.nhs.uk.
authors.forename: Michael
authors.initials: M
authors.lastname: Poullis
mesh_terms: D000367:Age Factors; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D015897:Comorbidity; D004739:England; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D065666:Mesenteric Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D008641:Mesenteric Vascular Occlusion / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D008875:Middle Aged; D015999:Multivariate Analysis; D016571:Neural Networks, Computer; D016017:Odds Ratio; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D013997:Time Factors; D065227:Transfusion Reaction; D016896:Treatment Outcome
keywords: Cardiac surgical procedures; hospital mortality; intestines; ischemia; risk factors