Acute
mesenteric ischemia is an uncommon but catastrophic event after
cardiopulmonary bypass. From 1980 to 1990, 16,951 cardiac procedures requiring
cardiopulmonary bypass were performed at Emory University Hospital in Atlanta, Ga. Eighteen patients (0.1%) had acute
mesenteric ischemia that resulted in intestinal
infarction. Emergency cardiac surgery had been performed in 16 of the 18 patients, and all 18 patients were vasopressor dependent for hemodynamic support after surgery. Diagnostic difficulties resulted in the diagnosis of intestinal
infarction an average of 9 1/2 days after
cardiopulmonary bypass. Nonocclusive mesenteric arterial
ischemia was the determined cause in all cases. Statistically significant risk factors associated with acute
mesenteric ischemia after
cardiopulmonary bypass surgery included (1) emergency cardiac surgery (p less than 0.0001), (2) the use of an intraaortic balloon pump (p less than 0.0001), (3) failed angioplasty requiring emergency surgery (p = 0.0074), (4) prolonged pump time (p = 0.0093), and (5) advanced age (p = 0.0016). A high index of suspicion for
mesenteric ischemia after
cardiopulmonary bypass in patients with identified risk factors may decrease the diagnostic delay and lead to an improvement in the 67% mortality rate seen in this series.