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Gastrointestinal complications after coronary artery bypass grafting
J T Christenson1, M Schmuziger, J Maurice
1Cardiovascular Surgery Unit, Hôpital de la Tour, Meyrin-Geneva & Clinique de Genolier, Switzerland.
Insights
Gastrointestinal complications after coronary artery bypass grafting (CABG) significantly increase mortality. Postoperative low cardiac output is a key predictor, suggesting splanchnic hypoperfusion as a common cause.
Area of Science:
- Cardiology
- Gastroenterology
- Surgical Outcomes
Background:
- Gastrointestinal (GI) complications following coronary artery bypass grafting (CABG) are associated with increased mortality.
- Identifying risk factors and etiologic factors for GI complications is crucial for improving patient outcomes.
Purpose of the Study:
- To identify clinical variables associated with GI complications in patients undergoing CABG.
- To determine common etiologic factors contributing to GI complications after CABG.
Main Methods:
- Retrospective analysis of clinical data from 3129 patients undergoing CABG.
- Multivariate analysis to identify independent predictors of GI complications.
- Comparison of mortality rates between patients with and without GI complications.
Main Results:
- GI complications occurred in 2.3% of patients, with a significantly higher mortality rate (16.4%) compared to those without (3.4%).
- Common complications included cholecystitis and intestinal ischemia.
- Independent predictors for GI complications were preoperative hypertension, advanced New York Heart Association class (III-IV), low ejection fraction (<40%), age >70, reoperation, and urgent operation.
- Postoperative low cardiac output was a significant independent predictor of GI complications.
- No significant correlation was found between GI complications and cardiopulmonary bypass time.
Conclusions:
- GI complications represent a significant risk factor for mortality after CABG.
- Postoperative low cardiac output and resultant splanchnic hypoperfusion are likely common etiologic factors.
- Risk stratification and management strategies should consider these identified factors to mitigate GI complications.
Abstract:
Clinical variables were studied in 3129 patients undergoing coronary artery bypass grafting to identify patients at risk of abdominal complications and common etiologic factors in the development of such complications. Seventy-three gastrointestinal complications occurred (2.3%), with an overall mortality rate of 16.4% compared with a mortality rate of 3.4% for all patients undergoing bypass grafting (p < 0.001). Cholecystitis and intestinal ischemia were the most frequently encountered complications. Multivariate analysis demonstrated that preoperative hypertension, New York Heart Association classes III and IV, preoperative left ventricular ejection fraction less than 40%, age greater than 70 years, reoperation, and urgent operation as independently and significantly associated with gastrointestinal complications. In contradiction to previous reports, no significant correlation existed between gastrointestinal complications and cardiopulmonary bypass time, 99.8 +/- 35.8 versus 101.2 +/- 39.8 minutes. Perioperative myocardial infarction and immediate postoperative hypotension with low cardiac output necessitating substantial inotropic pharmacologic support or intraaortic balloon pumping were significantly more prevalent in patients who had gastrointestinal complications (all p < 0.001). Furthermore, multivariate analysis revealed that postoperative low cardiac output was a significant, independent predictor in the development of gastrointestinal complications of any kind after coronary artery bypass grafting. Postoperative splanchnic hypoperfusion could therefore be a common etiologic factor.