Objective: To know the frequency of intraabdominal complications and its impact on survival of patients submitted to cardiopulmonary bypass for common open-heart surgical procedures.
Background: The gastrointestinal complications after cardiac surgery with cardiopulmonary bypass (CPB) have an incidence of 0.3 to 3% but mortality can exceed 60%. Despite improvements in preoperative, operative and postoperative care it has been the general impression that abdominal complications remain a significant problem.
Type of study: Retrospective case-control study.
Material and methods: Consecutive patients submitted to cardiac surgery with CPB between March 1995 to March 1997 were included. Any gastrointestinal complication was identified as well as its diagnosis, medical or surgical management and mortality.
Results: One thousand and three hundred fifty two patients were studied of which 516 (38%) were operated for coronary revascularization, 502 (37%) valvular replacement, 68 (5.2%) a combination of valvular replacement and revascularization, 144 (10.6%) correction of congenital defects and 122 (9.6%) treated of diverse problems. Forty-four patients developed complications (3.3%) and they were, postoperative intestinal ileus in 14 cases (32%), half of them had concomitant hyperamylasemia. Hepatobiliary complications represented 29.5% (13 cases). Ten patients (22.7%) developed peptic ulcer disease complicated with perforation or hemorrhage. Severe acute pancreatitis was observed in two patients as well as two with bowel necrosis. Three patients had complications considered not related to CPB as grade I liver trauma, acute appendicitis and amebic colitis. The mortality was 11/44 (25%). As a control group, 73 patients operated upon over the same time period and on the same days as the study patients were analyzed. The mortality in this group was 5/73 (6.8%). The medical history of peptic ulcer disease (< 0.01) and postoperative hemodynamic unstability (< 0.05), the use of intra-aortic balloon pump (< 0.05) and respiratory failure with prolonged ventilatory support (< 0.05) were separate statistical significant determinants for the development of postoperative abdominal complications.
Conclusions: Factors indicative of or contributing to periods of decreased end-organ perfusion appear to be significantly related to abdominal complications. Also, medical history of peptic ulcer disease represented an individual determinant of severe surgical complications as ulcer perforation and massive bleeding.