Monday October 09, 2006
Gastrointestinal Complications in Patients Undergoing Heart Operation

An important article published last year in Annals of Surgery 1 and should be read by intensivists working particularly in cardiothoracic units (CT-CV-ICU).

8709 Consecutive Cardiac Surgical Patients were analyzed for gastrointestinal complications. Though GI complications are rare (n = 46 - 0.53%) but need great vigilance of intensivist as these are life saving if identify early. Intensivist should not get deceived if surgery is off-pump 2 or minimally invasive (MIDCAB) 3.


Preoperative predictors of complication were

• Prior cerebrovascular accident (CVA),
• Chronic obstructive pulmonary disease (COPD),
• Heparin-induced thrombocytopenia (Type II),
• Atrial fibrillation,
• Prior myocardial infarction,
• Renal insufficiency,
• Hypertension, and
• need for intra-aortic balloon counter-pulsation (IABP).
  

The most frequent serious GI complication were

• Mesenteric ischemia (n = 31/46 or 67% of patients). 22 Twenty-two were explored and 14 died within 2 days of heart operation. Of the 9 patients with mesenteric ischemia who were not explored, 7 died within 3 days of heart operation.
• Diverticulitis (5/46),
• Pancreatitis (4/46),
• Peptic ulcer disease (4/46), and
• Cholecystitis (2/46).
  

Predictors of death from GI complication included

• New York Heart Association class III and IV heart failure,
• Smoking,
• Chronic obstructive pulmonary disease,
• History of syncope,
• AST more than 600U/L,
• Direct bilirubin more than 2.4mg/dL,
• PH less than 7.30, and
• The need for more than 2 pressors.
  
  Again! The biggest guard is high suspicion and constant vigilance.
  

References: click to get abstract or article

Gastrointestinal Complications in Patients Undergoing Heart Operation - Ann Surg. 2005 June; 241(6): 895–904.

Off-pump coronary artery bypass surgery does not reduce gastrointestinal complications. Eur J Cardiothorac Surg. 2003;23:170 --174

Acute Cholecystitis after Minimally Invasive Coronary Artery Bypass Grafting: A Report 2 Cases - The Heart Surgery Forum, Volume 9, Number 5 / October 2006