Gastrointestinal complications associated with cardiopulmonary bypass procedures.
Gastrointestinal complications after cardiopulmonary bypass (CPB) procedures are rare, but when they do occur, they carry a significant incidence of morbidity and mortality. Over a 5-year period spanning 1988-1992, 4923 CPB procedures were performed and 64 patients were identified who suffered a GI complication, giving an incidence of 1.3 per cent. The most frequent complications were GI bleeding (40%) and pancreatitis (34%). Other complications included acute cholecystitis (11%), perforated duodenal ulcer (8%), ischemic bowel (5%), and diverticulitis (2%). Complications occurred most frequently in patients undergoing procedures with longer pump and cross-clamp times, such as valvular and combination (CABG/valve) procedures. Redo procedures and the use of an intra-aortic balloon pump increased the risk of developing a GI complication 2.5 and 12 times, respectively. Patients were treated aggressively both medically and surgically, but suffered a higher mortality (16%) as compared to those not suffering a GI complication (3%). We conclude that GI complications after CPB procedures are infrequent but lethal. Clinical features are often subtle, and a high index of suspicion is needed for early diagnosis and aggressive treatment.
Mercado
P D
PD
Department of Cardiac Surgery, Kaiser Permanente Medical Center, Los Angeles, CA 90027.
Farid
H
H
O'Connell
T X
TX
Sintek
C F
CF
Pfeffer
T
T
Khonsari
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D006801:Humans; D015994:Incidence; D007223:Infant; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D013997:Time Factors