Abdominal complications following open-heart surgery: a report of 12 cases and review of the literature

Abstract

Introduction: Abdominal complications following open-heart surgery remain serious events as the mortality is reported to be tremendously high. The clinical presentation, the diagnostic strategy and the therapeutic management varies. We reviewed all records of those patients who developed abdominal complications with surgical consequences during the last five years, recorded a complete follow-up and compared the findings to a current view of the literature.

Patients and methods: Altogether 5720 patients underwent open-heart surgery at our institution between 1/98 and 12/02. Out of these 12 (10 men, 2 women) developed severe gastrointestinal complications with surgical consequences. The mean age was 73.17 +/- 8.1 I1 years. Seven patients underwent isolated coronary artery bypass grafting (CABG), two patients combined aortic valve replacement (AVR) and CABG, one isolated AVR, one mitral valve replacement (MVR) and yet another one combined MVR and CABG. The clinical records of all these patients were examined and a complete follow-up was recorded.

Results: The duration of the entire cardiac operation was a mean of 212.67 +/- 36.97 min, perfusion time 103 +/- 29.32 min and myocardial ischaemic time 52.25 +/- 24.56 min. Length of ICU-stay was between I and 5 days after cardiac surgery. Concerning gastrointestinal complications nine patients suffered from ischaemic intestinal disease, two from gastrointestinal ulcer bleeding and one from a preoperatively unknown bowel tumour with subsequent ileus. Four patients died in the immediate postoperative course, one patient within two years and seven patients show a satisfactory status at follow-up.

Conclusions: A review from the literature shows an enormous mortality from abdominal complications following open-heart surgery. This was also found in our series. As many of these patients have a history of abdominal disease more attention should be paid to such anamnestic hints in the preparation before cardiac surgery. Hence we recommend early diagnostic measures and explorative laparotomy in doubtful situations in patients with positive anamnesis.