Incidence of gastrointestinal complications in cardiopulmonary bypass patients

Byhahn, Christian; Strouhal, U.; Martens, Sven; Mierdl, S.; Kessler, Paul; Westphal, K.

doi:10.1007/bf03215861

Cited by 52 publications

(38 citation statements)

References 22 publications

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“…CPB can lead to a severe and complicated change of pathophysiology of the liver. Operation stress, reperfusion injur y, endotoxemia, and inflammatory reaction may contribute to the liver injury [6,10,11] , however, the complex functional and metabolic effects of hepatocyte in CPB require further investigation.…”

Section: Discussionmentioning

confidence: 99%

Hyperbilirubinemia after extracorporeal circulation surgery: A recent and prospective study

Ye²,

Zhong³

2006

WJG

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bilirubin, and is associated with a high mortality. Important contributing factors are the preoperative total bilirubin concentration, preoperative severity of right atrial pressure, numbers of valve replacement procedures, and the amount of blood transfusion requirement during and shortly after surgery. We suggest that postoperative hyperbilirubinemia is a multifactorial process, which is caused by both the impaired liver function of bilirubin transport and the increased production of bilirubin from haemolysis. INTRODUCTIONIt has long been recognized that early hyperbilirubinemia or transient jaundice could occur after extracorporeal circulation surg er y. According to earlier studies, overall incidence of postoperative hyperbilirubinemia ranges from about 8.6% to even as high as 40% [1][2][3] . Despite improvements in perioperative management, as well as in surgical and anaesthetic techniques, early hyperbilirubinemia after modern extracorporeal circulation surgery is still seen quite often. The high frequency of hyperbilirubinemia after cardiac surgery in our department prompted us to start a prospective study recently. It is aimed to clarify the incidence and nature of postoperative hyperbilir ubinemia in patients following moder n extracorporeal circulation, to analyze possible perioperative risk factors, and to elucidate the clinical significance of postoperative hyperbilirubinemia associated mortality and morbidity. Abstract AIM: To clarify the incidence and nature of postoperative hyperbilirubinemia in patients after modern e x t r a c o r p o r e a l c i r c u l a t i o n , t o a n a l y z e p o s s i b l e perioperative risk factors, and to elucidate the clinical significance of postoperative hyperbilirubinemia associated mortality and morbidity. MATERIALS AND METHODS Patients' backgrounds METHODS: Between March 2005 and May 2006, three hundred and eighty six consecutive patients undergoing extracorporeal circulation surgery due to a variety of cardiac lesions were investigated prospectively. The incidence of postoperative hyperbilirubinemia was defined as a serum total bilirubin concentration of more than 51 μmol/L. Several perioperative parameters w e r e c o m p a r e d b y l o g i s t i c r e g r e s s i o n b e t w e e n hyperbilirubinemia and non-hyperbilirubinemia patients to determine possible risk factors contributing to postoperative hyperbilirubinemia and mortality. R E S U LT S :O v e r a l l i n c i d e n c e o f p o s t o p e r a t i v e hyperbilirubinemia was 25.3% (98/386). In patients w i t h p o s t o p e r a t i v e h y p e r b i l i r u b i n e m i a , 5 6 . 2 % reached peak total bilirubin concentration on the first postoperative day, 33.5% on the second day, and 10.3% on the seventh day. Eighty percent of the increase of total bilirubin resulted from an increase of both conjugated and unconjugated bilirubin. Development of postoperative hyperbilirubinemia was associated with a higher mortality (P < 0.01), longer duration of mechanical ventilation (P < 0.05) and longer ICU stay ti...

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Section: Discussionmentioning

confidence: 99%

Hyperbilirubinemia after extracorporeal circulation surgery: A recent and prospective study

Ye²,

Zhong³

2006

WJG

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“…DISCUSSION CPB supported the development of intracardiac surgeries and complex procedures where a clean and static field is necessary, thus allowing for great advances in cardiac surgery. However, its harmlessness is questioned because of problems related with its use, which are mainly associated with prolonged perfusion time [9][10][11].…”

Section: Resultsmentioning

confidence: 99%

Revascularização híbrida do miocárdio: uma alternativa para reduzir o tempo de perfusão

Lopes¹,

Puig²,

Dallan³

et al. 2008

Rev Bras Cir Cardiovasc

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Conclusão: Utilizando-se a técnica híbrida é possível reduzir o tempo de CEC e a incidência de algumas complicações pós-operatórias. Provavelmente, esta redução nas incidências de fibrilação atrial e disfunção renal podem ser explicadas por uma redução na resposta da inflamatória conseqüente a um tempo de CEC menor.Descritores: Revascularização miocárdica/métodos. Vasos coronários/técnicas. Estudos retrospectivos. Circulação extracorpórea.

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“…[1][2][3][4] However, the majority of those reports were retrospective studies. Behrens et al performed a randomized trial for prophylaxis for upper GI lesions in high-risk pediatric heart surgery patients.…”

Section: Discussionmentioning

confidence: 99%

Prospective Randomized Trial for Optimal Prophylactic Treatment of the Upper Gastrointestinal Complications After Open Heart Surgery

Hata

Shiono

Sekino³

et al. 2005

Circ J

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astrointestinal disease is one of the serious complications that can follow after cardiac surgery, and can lead to high rates of morbidity and mortality. 1,2 Particularly, postoperative bleeding from the upper gastrointestinal (GI) system is quite lethal, because coagulopathy can develop as patients undergo anti-coagulant therapy. Therefore, prophylactic treatment for upper GI diseases after open heart surgery appears very necessary. Several investigators have reported the incidence and risk factors for stress ulceration and upper GI bleeding in patients after cardiac surgery. 3,4 However, there are no randomized controlled trials of the incidence of these lesions and the effects of prophylactic treatment in adult patients undergoing open heart surgery. We designed a prospective randomized trial to test the efficacy of different antisecretory agents, such as histamine-2 (H2)-receptor antagonists and a proton pump inhibitor (PPI) to prevent upper GI complications after open heart surgery.

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Incidence of gastrointestinal complications in cardiopulmonary bypass patients

Cited by 52 publications

References 22 publications

Hyperbilirubinemia after extracorporeal circulation surgery: A recent and prospective study

Hyperbilirubinemia after extracorporeal circulation surgery: A recent and prospective study

Revascularização híbrida do miocárdio: uma alternativa para reduzir o tempo de perfusão

Prospective Randomized Trial for Optimal Prophylactic Treatment of the Upper Gastrointestinal Complications After Open Heart Surgery

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