Visceral ischemia after cardiopulmonary bypass

The diagnosis and management of gastrointestinal complications associated w ith cardiopulmonary bypass is often hindered by a complicated clinical pict ure and equivocal examination. To better define the incidence, risk factors , and mortality, we reviewed the records of all patients undergoing cardiop ulmonary bypass from 1988 through 1996. The database for this study compris ed 14,521 patients who underwent cardiac surgery. The patients (543) with g astrointestinal complications were identified, and those with major complic ations (166) were individually reviewed. Major complications included pancr eatitis, gastritis, laparotomy, gastric ulcer, cholecystitis, colonic perfo ration, gastrointestinal bleeding, diverticulitis, bowel obstruction, perfo ration, and visceral ischemia. Our results were the following. 1) Gastroint estinal complications were noted in 3.7 per cent (543) of patients with maj or complications occurring in 1.2 per cent. In 166 patients, 187 major comp lications were noted. 2) Visceral ischemia, an infrequent but usually fatal (71%) complication, occurred in 24 (0.17%). 3) Of the ischemic events, 83 per cent (20 of 24) affected the bowel; with the colon involved 80 per cent of the time (16 of 20). 4) Patients with visceral ischemia were more likel y to be female (relative risk 2.1), have longer pump times (92.2 versus 74. 2), have cardiac procedures other than coronary artery bypass graft (relati ve risk 2.6), and have end-stage renal disease (relative risk 16.7). We con clude that, given the incidence and mortality related to visceral ischemia, especially to the colon, patients with risk factors tend-stage renal disea se, female sex, non-coronary artery bypass graft, and longer pump times) sh ould undergo routine endoscopic examination of the colon early after bypass and when clinically indicated thereafter.