POSTOPERATIVE VISCERAL HYPOTENSION THE COMMON-CAUSE FOR GASTROINTESTINAL COMPLICATIONS AFTER CARDIAC-SURGERY

In order to identify peroperative risk factors and to evaluate differe nt etiological factors in developing postoperative gastrointestinal co mplications, clinical variables were studied in 3493 patients undergoi ng adult cardiac surgery. There were 86 gastrointestinal complications , 2.9 %, with an overall mortality among these of 22.1 %: the mortalit y rate was 3.9 % for all patients undergoing cardiac surgery at our in stitution (p < 0.001). Paralytic ileus, intestinal ischemia, and acute cholecystitis were the most frequently seen complications. Arterial h ypertension, smoking and poor preoperative cardiac function, clinical instability, and the need for an emergency operation were distinct cli nical risk factors. Cardiopulmonary bypass time was, by itself, not an important factor. Embolic etiology was also ruled out. The incidence of peroperative myocardial infarction, low postoperative cardiac outpu t necessitating massive use of vasopressor substances and/or intraaort ic balloon pumping were significantly more often observed in patients who subsequently developed gastrointestinal complications. The common etiological factor in developing gastrointestinal complications of any kind, after cardiac surgery, seems to be postoperative splanchnic hyp operfusion with visceral ischemia. In order to reduce postoperative mo rbidity and mortality it is essential to identify patients at risk, su pport preoperative poor cardiac function, and to carefully monitor the se patients postoperatively for abdominal complications to reach an ea rly diagnosis.