Incidence and prognosis of abdominal complications after cardiopulmonary bypass

Abstract

The incidence of abdominal complications after cardiopulmonary bypass is low but associated with a high mortality. From January 1991 to October 1996, 4288 patients, of a mean age of 62.5 years, underwent open-heart surgery. Fifty-nine (1 of 4) of these patients developed early abdominal complications. These included 36% with a paralytic ileus, 21% with erosive gastritis, 18% with upper gastrointestinal haemorrhage, 12% with intestinal ischaemia, 5% with pseudo-obstruction of the colon, 6% with acute cholecystitis and 2% with acute pancreatitis. After coronary artery bypass grafting mean cardiopulmonary bypass time was 94.4 min. There were abdominal complications in 1.0% and one hospital death. After valve surgery and combined surgery the mean cardiopulmonary bypass time was 129 min. There were abdominal complications in 2.4% (α=0.01) and seven deaths. Fourteen patients (24%) underwent abdominal operations: three had caecostomies for pseudo-obstruction of the colon, seven had a hemicolectomy, two had a cholecystectomy and two had resection of the ventricle. The hospital mortality rate was 13.5%. Abdominal complications were significantly more frequent after valve or combined operations of the coronaries and valves in comparison with isolated coronary artery bypass grafting. Cardiac operations with extended cardiovascular bypass time were more likely to produce abdominal complications

Introduction

The development of abdominal complications after cardiac surgery, using cardiopulmonary bypass, is rare, and in retrospective studies the reported incidence was between 0.5 and 3.0% 1, 2. Although clinical occurrence is sporadic, abdominal complications are associated with high mortality (12-67%) 2, 3. Identification of risk factors for the development of abdominal complications has remained largely speculative. Several studies have shown that gastrointestinal complications are connected with prolonged cardiovascular bypass time [4]and insufficient splanchnic perfusion, which may be inadequate for metabolic needs 2, 4. The objective of this study was to determine the incidence of abdominal complications that occur after cardiac surgery using cardiovascular bypass, and to find the common factors that identify patients who are at risk from developing abdominal complications.