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Published on: March 23, 2018
Case control study of gastrointestinal complications after cardiopulmonary bypass heart surgery
Guowei Zhang1, Naishi Wu, Hongyu Liu
1Department of Cardio-Vascular Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China. godway@tom.com
Insights
Gastrointestinal complications after cardiopulmonary bypass (CPB) surgery are rare but dangerous. Key risk factors include longer CPB time and certain patient conditions, while higher perfusion pressure may be protective.
Area of Science:
- Cardiovascular Surgery
- Gastroenterology
- Critical Care Medicine
Background:
- Gastrointestinal complications (GIC) following cardiopulmonary bypass (CPB) surgery are infrequent but severe.
- Identifying risk factors for GIC is crucial for effective perioperative management.
- This study aimed to analyze perioperative factors associated with GIC in CPB patients.
Purpose of the Study:
- To identify perioperative risk factors for gastrointestinal complications after cardiopulmonary bypass surgery.
- To determine factors that may predict or protect against GIC in this patient population.
Main Methods:
- Retrospective analysis of 206 patients with GIC post-CPB surgery (2000-2007).
- Comparison with 206 matched control patients.
- Univariate and multiple logistic regression analyses were performed on 12 risk factors.
Main Results:
- CPB time, high preoperative serum creatinine, emergency surgery, low perfusion pressure, low cardiac output syndrome, advanced age, prolonged mechanical ventilation, and NYHA class III/IV were significant predictors of GIC.
- Higher perfusion pressure and aprotinin administration demonstrated protective effects.
Conclusions:
- GIC after CPB surgery are predictable based on identified risk factors.
- Maintaining higher perfusion pressure and reducing CPB and ventilation times may decrease the incidence of GIC.
Background:
Gastrointestinal complications (GIC) after cardiopulmonary bypass (CPB) surgery are rare, but, nevertheless, extremely dangerous.The identification of risks for GIC may be helpful in planning appropriate perioperative management strategies. The aim of the present study was to analyze perioperative factors of GIC in patients undergoing CPB surgery.
Methods:
We retrospectively analysed 206 patients who underwent GIC after cardiopulmonary bypass surgery from 2000 to 2007 and compared them with 206 matched control patients (matched for surgery, temperature, hemodilution and date). Univariate analysis and multiple logistic regression analysis were performed on 12 risk factors.
Result:
Sex and types of cardioplegia perfusate did not significantly influence the GIC after CPB surgery. Multiple logistic regression revealed that CPB time, preoperative serum creatinine (PSC) > or = 179 mg/dL, emergency surgery, perfusion pressure < or =40 mmHg, low cardiac output syndrome (LCOS), age > or = 61, mechanical ventilation > or =96 h, New York Heart Association (NYHA) class III and IV were predictors of the occurrence of GIC after CPB surgery. Perfusion pressure and aprotinin administration were protective factors.
Conclusion:
Gastrointestinal complications after CPB surgery could be predictive in the presence of the above risk factors. This study suggests that GIC can be reduced by maintenance of higher perfusion pressure and shortening the time on CPB and ventilation.
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