GASTROINTESTINAL COMPLICATIONS AFTER CORONARY-ARTERY BYPASS-GRAFTING

Clinical variables were studied in 3129 patients undergoing coronary a rtery bypass grafting to identify patients at risk of abdominal compli cations and common etiologic factors in the development of such; compl ications. Seventy-three gastrointestinal complications occurred (2.3%) , with an overall mortality rate of 16.4% compared,vith a mortality ra te of 3.4% for all patients undergoing bypass grafting (p < 0.001), Ch olecystitis and intestinal ischemia were the most frequently encounter ed complications. Multivariate analysis demonstrated that preoperative hypertension, New York Heart Association classes III and IV, preopera tive left ventricular ejection fraction less than 40%, age greater tha n 70 years, reoperation, and urgent operation as independently and sig nificantly associated with gastrointestinal complications. In contradi ction to previous reports, no significant correlation existed between gastrointestinal complications and cardiopulmonary bypass time, 99.8 /- 35.8 versus 101.2 +/- 39.8 minutes. Perioperative myocardial infarc tion and immediate postoperative hypotension with low cardiac output n ecessitating substantial inotropic pharmacologic support or intraaorti c balloon pumping were significantly more prevalent in patients who ha d gastrointestinal complications (all p < 0.001). Furthermore, multiva riate analysis revealed that postoperative low cardiac output was a si gnificant, independent predictor in the development of gastrointestina l complications of any kind after coronary artery bypass grafting. Pos toperative splanchnic hypoperfusion could therefore be a common etiolo gic factor.