Gastrointestinal Complications following Cardiac Surgery: A Comprehensive Review

Abstract

Gastrointestinal (GI) complications following cardiac surgery are associated with a high morbidity and mortality, prolonged hospital stay and increased cost of hospitalization. A literature search was carried out using Medline for articles published in the past 30 years. Prospective and retrospective papers that dealt with coronary artery bypass grafting (CABG), CABG/valve operations were selected and those that dealt with thoracic and transplant complications were excluded. We reviewed 151,652 patients reported over the past 30 years; GI complications occurred on average after 1.21% of cardiac operations and had an associated mortality of 34.1%. The most common risk factors identified include age greater than 70 years, low cardiac output, peripheral vascular disease, reoperative surgery, chronic renal insufficiency, increased number of blood transfusions, prolonged cardiopulmonary bypass time, arrhythmias, and use of an intraaortic balloon pump. A critical examination of the available literature revealed multifactorial etiologies (often related to hypoperfusion) leading to GI complications. Delayed diagnosis was associated with poor outcomes. GI complications are rare events, but early diagnosis is essential. Unfortunately few of the risk factors we have defined are specific and are often indicators of ill patients. A low threshold to initiate laboratory evaluation and/or imaging studies should be employed if a patient shows signs of deviating from the normal course following cardiac surgery.