[Abdominal complications after heart surgery interventions].

Abt. für Herzchirurgie, Allgemeines Krankenhaus St. George, Hamburg.
Zentralblatt für Chirurgie (Impact Factor: 1.19). 02/1997; 122(10):893-7.
Source: PubMed

ABSTRACT Risk factors of abdominal complications after cardiac surgery are largely unknown. We undertook this study to determine different types of abdominal complications after cardiac surgery and to identify patients at risk.
3312 adult patients were operated between Jan. 91 and Oct. 95 (2352 males, 960 females, 62.6 +/- 0.18y). We included all patients who suffered from abdominal complications within 30 days postoperatively.
Abdominal complications are rare after cardiac surgery using cardiopulmonary bypass (CPB) (1.4%), but they are associated with high mortality (14.5%) in our department. Abdominal complications like paralytic ileus (43.8%), erosive gastritis (22.9%) and gastrointestinal bleeding (18.8%) are more often, compared with acute cholecystitis (14.5%), acute pancreatitis (8.3%) and intestinal ischemia (19.5%). Patients with intestinal ischemia are at high risk and do have a high mortality (83%). Abdominal complications can be found more often in connection with prolonged myocardial ischemia and valve replacement or combined operations. Prediction of complications on the basis of anamnestic data alone was not possible.
Abdominal complications after cardiac surgery, especially intestinal ischaemia, are life-threatening. Prediction of abdominal complications is impossible. We have to concentrate on an early diagnosis and therapeutic intervention to lower mortality. A close cooperation between cardiac and general surgeons is mandatory for a successful treatment of life-threatening abdominal complications such as intestinal ischemia.

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    ABSTRACT: BACKGROUND: To summarize the diagnostic and therapeutic experiences on the patients who suffered abdominal complications after cardiovascular surgery with cardiopulmonary bypass(CPB). METHODS: A total of 2349 consecutive patients submitted to cardiovascular surgery with CPB in our hospital from Jan 2004 to Dec 2010 were involved. The clinical data of any abdominal complication, including its incidence, characters, relative risks, diagnostic measures, medical or surgical management and mortality, was retrospectively analyzed. RESULTS: Of all the patients, 33(1.4%) developed abdominal complications postoperatively, including 11(33.3%) cases of paralytic ileus, 9(27.3%) of gastrointestinal haemorrhage, 2(6.1%) of gastroduodenal ulcer perforation, 2(6.1%) of acute calculus cholecystitis, 3(9.1%) of acute acalculus cholecystitis, 4(12.1%) of hepatic dysfunction and 2(6.1%) of ischemia bowel diseases. Of the 33 patients, 26 (78.8%) accepted medical treatment and 7 (21.2%) underwent subsequent surgical intervention. There were 5(15.2%) deaths in this series, which was significantly higher than the overall mortality (2.7%). Positive history of peptic ulcer, advanced ages, bad heart function, preoperative IABP support, prolonged CPB time, low cardiac output and prolonged mechanical ventilation are the risk factors of abdominal complications. CONCLUSIONS: Abdominal complications after cardiovascular surgery with CPB have a low incidence but a higher mortality. Early detection and prompt appropriate intervention are essential for the outcome of the patients.
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