Complications involving gall bladder and biliary tract in cardiovascular surgery

This study aimed to ascertain the frequency of biliary complications following cardiac surgery, to determine preoperative risk factors and to identify the significance of prompt diagnosis and institution of therapy.

All patients who underwent open-heart surgery (4588 patients) during a period of 3 years were examined prospectively for complications involving gall bladder and biliary tract. Patients with preoperative hepatic dysfunction or biliary disorders were excluded from this study.

Biliary complications occurred in 14 patients. Gangrene of gallbladder (n=5) and acute acalculous cholecystitis (n = 5) were the most common complications followed by distension of the common bile duct (n = 2), cholelithiasis (n = 1) and empyema (n = 1). The majority of complications presented within the 3rd postoperative week. Chole cystectomy was performed in 5 patients and percutaneous drainage of the gallbladder in 7. Mortality rate was 43%. Biliary complications correlated with advanced age, the male sex, combined surgical procedures, preoperative low cardiac output syndrome, prolonged bypass and aortic cross-clump time, mechanical ventilation, the usage of Intra-Aortic Balloon Pumping, multiple transfusions and the administration of inotrops.

Biliary complications after cardiac surgery are uncommon but life threatening and may result from hypoperfusion. Clinical features are often subtle, and a high index of suspicion is necessary for an early diagnosis and appropriate treatment.