• Humans
• Mesenteric Ischemia/physiopathology
• Mesenteric Ischemia/therapy
• Mesenteric Ischemia/mortality
• Mesenteric Ischemia/diagnosis
• Mesenteric Ischemia/epidemiology
• Mesenteric Ischemia/diagnostic imaging
• Mesenteric Ischemia/etiology
• Risk Factors
• Splanchnic Circulation
• Treatment Outcome
• Vascular Surgical Procedures/adverse effects
• Vascular Surgical Procedures/mortality
• Aortic Dissection/surgery
• Aortic Dissection/physiopathology
• Aortic Dissection/mortality
• Aortic Dissection/diagnostic imaging
• Predictive Value of Tests
• Risk Assessment
• Vasoconstriction
• Aortic Aneurysm/surgery
• Aortic Aneurysm/mortality
• Aortic Aneurysm/physiopathology
• Mesenteric Arteries/physiopathology

• Angiography
• Artificial intelligence
• Cholangiography
• Emergency
• Fluorescence
• Indocyanine green
• Modern surgery
• Practice
• Precision
• Surgery
• Technology
• World society of emergency surgery

• Humans
• Indocyanine Green/therapeutic use
• Consensus
• Surgery, Computer-Assisted/methods
• Surgery, Computer-Assisted/standards
• Optical Imaging/methods
• Delphi Technique

• nutritional support
• early enteral nutrition
• valvular heart disease
• high-risk elderly patients
• gastrointestinal complications
• retrospective study

• Humans
• Male
• Female
• Retrospective Studies
• Aged
• Heart Valve Diseases/surgery
• Postoperative Complications
• Nutritional Support/methods
• Middle Aged
• Length of Stay
• Postoperative Care
• Enteral Nutrition/methods

• acute cholecystitis
• cardiac surgery
• gastrointestinal complications
• ischemia

• Cardiac surgery
• Colon perforation
• Cytomegalovirus colitis

• critical illness
• energy and nutrient supply
• extracorporeal membrane oxygenation
• medical nutrition therapy
• monitoring
• nutrition status/risk
• practical guidance

• Atherosclerosis
• Mesenteric ischemia
• Multidetector computed tomography
• Nonocclusive mesenteric ischemia

• Critically ill
• Mesenteric ischemia
• Observational
• Plasma citrulline
• Plasma intestinal-fatty acid binding protein

• Basedow's disease
• Non-occlusive mesenteric ischemia
• Trans-catheter aortic valve implantation

• Enteral feeding
• Hepatic portal venous gas
• Non-occlusive mesenteric ischemia
• Pneumatosis intestinalis

• 3D-CT = three-dimensional computed tomography
• AKA = Adamkiewicz artery
• CT = computed tomography
• HK = Hunt and Kosnik
• HPVG = hepatic portal venous gas
• IC-PComA = internal carotid–posterior communicating artery
• ICU = intensive care unit
• MCA = middle cerebral artery
• MDCT = multidetector-row computed tomography
• MIP = maximum-intensity projection
• NOMI = nonocclusive mesenteric ischemia
• SAH = subarachnoid hemorrhage
• SMA = superior mesenteric artery
• complication
• nonocclusive mesenteric ischemia
• subarachnoid hemorrhage
• vasospasm

• bowel ischemia
• critical illness
• enteral nutrition
• heart failure
• heart transplantation
• parenteral nutrition
• ventricular assist device

• biomarkers
• bowel ischemia
• cardiac surgery
• mesenteric ischemia

Acute mesenteric ischemia is a life-threatening complication after cardiovascular surgery with a mortality rate of 52.9–81.3%. However, few studies have evaluated the predictors of clinical outcome after treatment for acute mesenteric ischemia following cardiovascular surgery. Therefore, this study aimed to elucidate prognostic factors in patients who underwent laparotomy for acute mesenteric ischemia after cardiovascular surgery.

We retrospectively analyzed 29 patients (20 men and 9 women; median age, 71.0 years) who underwent laparotomy for acute mesenteric ischemia after cardiovascular surgery between January 2010 and August 2020. These patients were classified into the survivor group (comprising patients who were discharged or referred to another hospital, n = 16) and the nonsurvivor group (comprising those who experienced in-hospital mortality, n = 13). We compared clinical parameters between the groups to identify the predictors of outcomes.

More patients in the nonsurvivor group underwent emergency cardiovascular surgery (62.5% vs. 100%, p = 0.017) and received hemodialysis (12.5% vs. 61.5%, p = 0.008) at the onset of acute mesenteric ischemia than those in the survivor group. The prelaparotomy serum creatinine level was higher in the nonsurvivor group than in the survivor group (1.27 vs. 2.33 mg/dL, p = 0.004). Logistic regression analysis revealed an association between preoperative serum creatinine level and in-hospital mortality (odds ratio 5.047, p = 0.046), and Cox regression analysis demonstrated a relationship between serum creatinine level and in-hospital mortality (hazard ratio 1.610, p = 0.009). The area under the curve (receiver operating characteristic analysis) for the serum creatinine level was 0.813. Furthermore, the optimal cutoff value of the serum creatinine level was 1.59 mg/dL with a sensitivity and specificity of 0.846 and 0.687, respectively, in predicting in-hospital mortality.

The elevated serum creatinine level was associated with a poor clinical outcome after surgery for acute mesenteric ischemia following cardiovascular surgery.

• Artificial intelligence
• Biomarkers
• Critically ill
• Machine learning
• Mesenteric ischemia

• Artificial Intelligence
• Critical Illness
• Diagnostic Imaging
• Humans
• Ischemia
• Mesenteric Ischemia/diagnostic imaging
• Prognosis

• atherosclerosis
• cholesterol crystal embolization
• pancreatitis
• perforation

• Cholesterol
• Embolism, Cholesterol/diagnosis
• Humans

• Early surgical decision
• Ischemia biomarkers
• Mechanical intestinal obstruction

• acute mesenteric ischemia
• cardiovascular surgery
• case-control study
• intraoperative parameter
• lactate

• Abdominal complications
• Cardiopulmonary bypass
• Coronary artery bypass grafting
• Risk factors
• Risk score

To evaluate the feasibility of 2D-perfusion angiography (2D-PA) for the analysis of intra-procedural treatment response after intra-arterial prostaglandin E1 therapy in patients with non-occlusive mesenteric ischemia (NOMI).

Overall, 20 procedures in 18 NOMI patients were included in this retrospective case–control study. To evaluate intra-procedural splanchnic circulation changes, post-processing of digital subtraction angiography (DSA) series was performed. Regions of interest (ROIs) were placed in the superior mesenteric artery (SMA; reference), the portal vein (PV; ROI_PV), as well as the aorta next to the origin of the SMA (ROI_Aorta). Peak density (PD), time to peak (TTP), and area under the curve (AUC) were assessed, and parametric ratios ‘target ROI_{PD, TTP, AUC}/reference ROI’ were computed and compared within treatment and control group. Additionally, a NOMI score was assessed pre- and post-treatment compared to 2D-PA.

Vasodilator therapy leads to a significant decrease of the 2D-PA-derived values PD_Aorta (p = 0.04) and AUC_Aorta (p = 0.03). These findings correlated with changes of the simplified NOMI score, both for overall (4 to 1, p < 0.0001) and for each category. Prostaglandin application caused a significant increase of the AUC_PV (p = 0.04) and TTP_PV was accelerated without reaching statistical significance (p = 0.13). When compared to a control group, all 2D-PA values in the NOMI group (pre- and post-intervention) differed significantly (p < 0.05) with longer TTP_Aorta/PV and lower AUC_Aorta/PV and PD _Aorta/PV.

2D-PA offers an objective approach to analyze immediate flow and perfusion changes following vasodilatory therapies of NOMI patients and may be a valuable tool for assessing treatment response.

• 2D-Perfusion angiography
• Digital subtraction angiography
• Non-occlusive mesenteric ischemia
• Treatment efficacy

• Bifurcation stenting
• end-stage renal disease
• left main trunk

• Acute cardiovascular care
• cardiac arrest
• cardiogenic shock
• mesenteric ischaemia
• veno-arterial ECMO

• Cardiac surgery
• Nonocclusive mesenteric ischemia
• Postoperative complication

• Coronary artery bypass
• chronic
• heart valve diseases
• peripheral arterial disease
• prognosis
• renal dialysis
• renal insufficiency

To analyze demography, clinical signs, and survival of intensive care patients diagnosed with nonocclusive mesenteric ischemia (NOMI) and to evaluate the effect of a local intra-arterial prostaglandin therapy.

Retrospective observational study screening 455 intensive care patients with acute arterial mesenteric perfusion disorder in a tertiary care hospital within the past 8 years. Lastly, 32 patients with NOMI were enrolled, of which 11 received local intra-arterial prostaglandin therapy. The diagnosis of NOMI was based on the clinical presentation and established biphasic computed tomography criteria. Clinical and biochemical data were obtained 24 hours before, at the time, and 24 hours after diagnosis.

Patients were 60.5 (49.3-73) years old and had multiple comorbidities. Most of them were diagnosed with septic shock requiring high doses of norepinephrine (NE: 0.382 [0.249-0.627] μg/kg/min). The Sequential Organ Failure Assessment (SOFA) score was 18 (16-20). A decrease in oxygenation (Pao₂/Fio₂), pH, and bicarbonate and an increase in international normalized ratio, lactate, bilirubin, leucocyte count, and NE dose were early indicators of NOMI. Median SOFA score significantly increased in the last 24 hours before diagnosis of NOMI (16 vs 18, P < .0001). Overall, 28-day mortality was 75% (81% nonintervention vs 64% intervention cohort; P = .579). Median SOFA scores 24 hours after intervention increased by +5% in the nonintervention group and decreased by 5.5% in the intervention group (P = .0059).

Our data suggest that NOMI is a detrimental disease associated with progressive organ failure and a high mortality. Local intra-arterial prostaglandin application might hold promise as a rescue treatment strategy. These data encourage future randomized controlled trials are desirable.

• intestinal failure
• nonocclusive mesenteric ischemia
• sepsis
• shock

Mesenteric ischemia (MESI) is a rare but often fatal complication in patients after cardiac surgery. Non-specific clinical symptoms and lack of specific laboratory parameters complicate the diagnosis. We evaluated potential serum markers for MESI in cardiac surgery patients.

Between March and October 2012, serial serum samples of 567 elective cardiac surgery patients were collected 1, 24, and 48 h after the operation, and concentrations of potential markers for MESI [α-glutathione-S-transferase (αGST), intestinal fatty-acid-binding protein (iFABP), and D-lactate] were measured retrospectively. In patients requiring laparotomy, blood samples obtained 72, 48, 24, and 12 h before the laparotomy were additionally measured and compared to all other patients (control group).

Laparotomy was performed in 18 patients at 11±7 days after cardiac surgery. MESI was found in 9/18 patients. Already 1 h after cardiac surgery, the serum concentrations of D-lactate (37±18 vs. 25±20 nmol/mL, p<0.01) and αGST (82±126 vs. 727±1382 μg/L, p<0.01) in patients undergoing laparotomy were increased compared to the control group. Between patients with and without MESI, differences were only found for iFABP 24 h after cardiac surgery (1.1±0.4 vs. 2.9±0.6 ng/mL, p=0.04) and up to 72 h before laparotomy (0.56±0.72 vs. 2.51±1.96 ng/mL, p=0.01).

D-lactate and αGST were early markers for gastrointestinal complications after cardiac surgery. Before laparotomy, lowered iFABP levels indicated MESI. Routinely used, these markers can help identify patients with gastrointestinal complications after cardiac surgery early, and might be useful for the evaluation of new therapeutic or preventive strategies.

• D-lactate
• biomarker
• cardiac surgery
• iFABP
• mesenteric ischemia
• αGST

Nonocclusive mesenteric ischemia (NOMI) is a rare but life-threatening complication after cardiovascular surgery. Early diagnosis and treatment is essential for a chance to cure. The aim of this study is to identify the independent risk factors for NOMI based on the evaluation of 12 cases of NOMI after cardiovascular surgery.

We retrospectively analyzed 12 patients with NOMI and 674 other patients without NOMI who underwent cardiovascular surgery in our hospital. We reviewed the clinical data on NOMI patients, including their characteristics and the clinical course. In addition, we performed a statistical comparison of each factor from both NOMI and non-NOMI groups to identify the independent risk factors for NOMI.

The median duration between the cardiac surgery and the diagnosis of NOMI was 14.0 (10.3–20.3) days. The in-hospital mortality of NOMI patients was 75.0%. Age (p < 0.05), peripheral arterial disease (p < 0.001), postoperative hemodialysis (p < 0.001), intraaortic balloon pump (p < 0.05), norepinephrine (NOE) > 0.10γ (p < 0.0001), percutaneous cardiopulmonary support (p < 0.001), sepsis (p < 0.05), loss of sinus rhythm (p < 0.05), prolonged ventilation (p < 0.0001), and resternotomy for bleeding (p < 0.05) showed significant differences between NOMI and non-NOMI groups. In the multivariate logistic regression model, prolonged ventilation [odds ratio (OR) = 18.1, p < 0.001] and NOE > 0.10 μg/kg/min (OR = 130.0, p < 0.0001) were detected as independent risk factors for NOMI.

We have identified the risk factors for NOMI based on the evaluation of the 12 cases of NOMI after cardiovascular surgery. This result may be useful in predicting NOMI, which is considered difficult in clinical practice. For the patient with suspected of NOMI who has these risk factors, early CT scan and surgical exploration should be performed without delay.

• Cardiovascular surgery
• Nonocclusive mesenteric ischemia
• Risk model

• cardiopulmonary bypass
• intestinal ischemia
• multiple organ failure
• score
• sepsis
• systemic inflammatory response syndrome

• Toll-like receptors
• intestinal ischemia reperfusion injury
• microbiome
• oxidative stress

• Acute mesenteric ischaemia
• Arterial embolism
• Arterial thrombosis
• Chronic mesenteric ischaemia
• Guidelines
• Isolated dissections of the mesenteric arteries
• Mesenteric arterial aneurysms
• Mesenteric venous thrombosis
• Non-occlusive mesenteric ischaemia
• Venous mesenteric ischaemia

• Endovascular Procedures/adverse effects
• Endovascular Procedures/standards
• Humans
• Mesenteric Arteries/diagnostic imaging
• Mesenteric Arteries/physiopathology
• Mesenteric Arteries/surgery
• Mesenteric Veins/diagnostic imaging
• Mesenteric Veins/physiopathology
• Mesenteric Veins/surgery
• Predictive Value of Tests
• Risk Factors
• Splanchnic Circulation
• Treatment Outcome
• Vascular Diseases/diagnostic imaging
• Vascular Diseases/physiopathology
• Vascular Diseases/therapy
• Vascular Surgical Procedures/adverse effects
• Vascular Surgical Procedures/standards

• Acute mesenteric ischemia
• Arterial embolism
• Arterial thrombosis
• Chronic mesenteric ischemia
• Mesenteric venous thrombosis
• Nonocclusive mesenteric ischemia

• Indocyanine green fluorescence
• Non-occlusive mesenteric ischemia
• Open-abdomen management

• colon
• ischemia
• necrosis
• perforation
• sepsis

• cardiac surgery
• lactate
• laparotomy
• nonocclusive mesenteric ischemia
• vasoactive-inotropic agent

• Age Factors
• Aged
• Biomarkers/blood
• Cardiac Surgical Procedures
• Case-Control Studies
• Female
• Humans
• Lactic Acid/blood
• Male
• Mesenteric Ischemia/diagnosis
• Mesenteric Ischemia/epidemiology
• Middle Aged
• Postoperative Complications/diagnosis
• Postoperative Complications/epidemiology
• Prognosis
• Random Allocation
• Risk Assessment
• Risk Factors
• Sigmoidoscopy
• Survival Analysis
• Tomography, X-Ray Computed

To evaluate the value of preoperatively assessed fibroblast growth factor 23 (FGF-23) levels and to correlate FGF-23 with angiographic findings in non-occlusive mesenteric (NOMI) ischemia using a standardized scoring system.

Between 2/2011 and 3/2012 a total of 865 patients (median age: 67 years) underwent cardiovascular surgery during this ethics committee approved, prospective study. 65 of these patients had clinical suspicion of NOMI and consequently underwent catheter angiography of the superior mesenteric artery. Images were assessed using a standardized reporting system (Homburg-NOMI-Score). These data were correlated to following preoperative parameters of kidney function: cystatin C, creatinine, FGF-23 and estimated glomerular filtration rate (eGFR), and outcome data (death, acute renal failure) using linear and logistic regressions, as well as nonparametric tests.

Significant correlations were found between FGF-23 and the angiographic appearance of NOMI (p = 0.03). Linear regression analysis showed no significant correlation to the severity of NOMI with creatinine (p = 0.273), cystatin C (p = 0.484), cystatin C eGFR (p = 0.914) and creatinine eGFR (p = 0.380). Logistic regression revealed a significant correlation between death and the Homburg-NOMI-Score (p<0.001), but not between development of NOMI and acute renal failure (p = 0.122). The ROC Analysis yielded an area under the curve of 0.695 (95% CI: 0.627–0.763) with a sensitivity of 0.672 and specificity of 0.658.

FGF-23 significantly correlates with the severity of NOMI, which is in contrast to other renal function parameters. The applied scoring system allows to predict mortality in NOMI patients.