[Severe digestive complications after heart surgery using extracorporeal circulation].

Area of Science:

• Cardiovascular Surgery
• Gastroenterology
• Critical Care Medicine

Background:

• Gastrointestinal complications represent a significant challenge in patients undergoing cardiac surgery with extracorporeal circulation (ECC).
• Understanding the incidence and risk factors associated with these complications is crucial for improving patient outcomes.

Purpose of the Study:

• To determine the incidence, circumstances of occurrence, and evolution of gastrointestinal complications after cardiac surgery involving ECC.
• To identify patient-specific and procedure-related factors associated with these complications and their impact on mortality.

Main Methods:

• A retrospective chart review was conducted on 6,281 patients who underwent cardiac surgery with ECC between January 1994 and December 1997.
• Data collected included patient demographics, surgical details, occurrence of gastrointestinal complications, and mortality outcomes.

Main Results:

• Gastrointestinal complications occurred in 1% of patients (60 out of 6,281), with upper gastrointestinal bleeding and paralytic ileus being the most common.
• Higher incidence rates were observed in patients undergoing cardiac transplantation (6%) and surgery for acute aortic dissection (9%).
• Patients with gastrointestinal complications had higher Parsonnet scores, more emergency surgeries, longer ECC durations, and a greater incidence of low cardiac output post-surgery. The mortality rate was 52%, with sepsis, renal failure, and advanced age being significant risk factors.

Conclusions:

• Gastrointestinal complications after ECC are predominantly seen in high-risk surgical patients.
• These complications are often associated with other adverse events, leading to a substantially elevated mortality rate.
• Early recognition and management of risk factors, particularly sepsis, are critical for improving survival in this patient population.