Virchow's triad and intestinal ischemia post cardiac surgery

Asian Cardiovasc Thorac Ann. 2014 Oct;22(8):927-34. doi: 10.1177/0218492314522252. Epub 2014 Feb 19.


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.

Keywords: Cardiac surgical procedures; hospital mortality; intestines; ischemia; risk factors.

MeSH terms

  • Age Factors
  • Aged
  • Cardiac Surgical Procedures / adverse effects*
  • Cardiac Surgical Procedures / mortality
  • Comorbidity
  • England
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Logistic Models
  • Male
  • Mesenteric Ischemia / diagnosis
  • Mesenteric Ischemia / etiology*
  • Mesenteric Ischemia / mortality
  • Mesenteric Ischemia / prevention & control
  • Mesenteric Vascular Occlusion / diagnosis
  • Mesenteric Vascular Occlusion / etiology*
  • Mesenteric Vascular Occlusion / mortality
  • Mesenteric Vascular Occlusion / prevention & control
  • Middle Aged
  • Multivariate Analysis
  • Neural Networks, Computer
  • Odds Ratio
  • Postoperative Hemorrhage / etiology
  • Postoperative Hemorrhage / surgery
  • Reoperation
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Sex Factors
  • Thrombosis / diagnosis
  • Thrombosis / etiology*
  • Thrombosis / mortality
  • Thrombosis / prevention & control
  • Time Factors
  • Transfusion Reaction
  • Treatment Outcome