Gastrointestinal complications after cardiac surgery with extracorporeal circulation

Purpose: io determine the incidence, circumstances of occurrence and evolut ion of gastrointestinal complications after cardiac surgery with extracorpo real circulation (ECC), Methods: Retrospective chart study of gastrointestinal complications in 6,2 81 patients undergoing ECC between January 1994 and December 1997. Results: Sixty patients developed 68 gastrointestinal complications (1%). C omplications included: upper gastrointestinal bleeding(n = 23), intestinal ischemia (n = 19), cholecystitis(n = 7), pancreatitis (n = 6), and paralyti c ileus (n = 16). The incidence of these complications was lay after corona ry artery (0.4%) or valvular surgery (0.8%) and high after cardiac transpla ntation (6%) and after surgery for acute aortic dissection (9%), Compared w ith a control population, patients with gastrointestinal complication had a higher Parsonnet score (29 +/- 15 vs 13 +/- 12 points; P = 0.002), were mo re frequently operated upon as an emergency (40/60, 66% vs 1120/6221, 18%; P = 0.01), underwent ECC of longer duration(114 +/- 66 vs 74 +/- 42 min; P = 0.01), and presented more frequently with low cardiac output after surger y (45/60, 75% vs 435/6221, 7%; P = 0.001). The mortality rate after gastroi ntestinal complications was 52%. The major factor associated with mortality was the occurence of sepsis (OR = 38.7). Other factors were: renal failure (OR = 7.9), age > 75 yr (OR = 3.5), mechanical ventilation for more than s even days (OR = 2.7), associated cerebral damage (OR = 3.9). Conclusion: Gastrointestinal complications after ECC occur in high risk sur gical patients, These complications are frequently associated with other co mplications leading to a high mortality rate.