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The Annals of Thoracic Surgery, Vol 52, 826-831, Copyright © 1991 by The Society of Thoracic Surgeons
SK Ohri, JB Desai, JA Gaer, JB Roussak, M Hashemi, PL Smith and KM Taylor
Thirty-three intraabdominal complications occurred in 27 patients over a
16-year period in 4,629 patients who underwent cardiopulmonary bypass
(0.58% incidence). The mortality was 14.8% for the intraabdominal
complication group compared with 3.4% for the control group of patients (p
less than 0.01). The most common complication was gastrointestinal
hemorrhage (n = 20), of which esophagitis (n = 6) was the most common
cause. However, patients with duodenal ulcer (n = 4) had the highest
mortality; 2 patients who underwent truncal vagotomy and pyloroplasty
subsequently died. Two further patients underwent operation for perforated
anterior duodenal ulcers without further morbidity. Cholecystitis developed
in 5 patients and acute pancreatitis in 4; all were managed nonoperatively
with no mortality. Multisystem organ failure developed in 2 patients, of
whom 1 died. There was a significant correlation between intraabdominal
complications and prolonged bypass time. The mean bypass time was 96.7 +/-
28.6 minutes for the patients with gastrointestinal complications, compared
with 81.7 +/- 48.4 minutes for the whole group (p less than 0.01). No
correlation was demonstrated for type of operation undergone or the age of
the patient. In the last 5 years, 2,145 patients underwent cardiopulmonary
bypass, of whom 562 received pulsatile and 1,583 nonpulsatile flow. The
incidence of intraabdominal complications was 0.18% (n = 1) in the
pulsatile group compared with 0.63% (n = 10) for the nonpulsatile group (p
= 0.14). Intraabdominal complications, although of low incidence, carry a
significantly high mortality, and the clinician must be alert in the
postoperative period to institute early therapy.
ARTICLES
Intraabdominal complications after cardiopulmonary bypass
Department of Cardiothoracic Surgery, Royal Postgraduate Medical School, Hammersmith Hospital, London, England.
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