CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2014; 05(03): 101-105
DOI: 10.4103/0976-5042.147501
Original Article
Society of Gastrointestinal Endoscopy of India

Upper gastrointestinal bleeding after open heart surgery

Aithoussa Mahdi
Departments of Cardiac Surgery, Mohammed V Military Hospital, Rabat, Morocco
,
Atmani Noureddine
Departments of Cardiac Surgery, Mohammed V Military Hospital, Rabat, Morocco
,
Moutakiallah Younes
Departments of Cardiac Surgery, Mohammed V Military Hospital, Rabat, Morocco
,
Bamous Mehdi
Departments of Cardiac Surgery, Mohammed V Military Hospital, Rabat, Morocco
,
Abdou Abdessamad
Departments of Cardiac Surgery, Mohammed V Military Hospital, Rabat, Morocco
,
Nya Fouad
Departments of Cardiac Surgery, Mohammed V Military Hospital, Rabat, Morocco
,
Seghrouchni Aniss
Departments of Cardiac Surgery, Mohammed V Military Hospital, Rabat, Morocco
,
Wahid Fouad Amal
Departments of Cardiac Surgery, Mohammed V Military Hospital, Rabat, Morocco
,
Drissi Mohamed
1   Department of Cardiac Surgery Reanimation of Cardiac Surgery, Mohammed V Military Hospital, Rabat, Morocco
,
Hatim Ghadbane Abdedaim
1   Department of Cardiac Surgery Reanimation of Cardiac Surgery, Mohammed V Military Hospital, Rabat, Morocco
,
El Bekkali Youssef
Departments of Cardiac Surgery, Mohammed V Military Hospital, Rabat, Morocco
,
Boulahya Abdelatif
Departments of Cardiac Surgery, Mohammed V Military Hospital, Rabat, Morocco
› Author Affiliations
Further Information

Publication History

Publication Date:
26 September 2019 (online)

Abstract

Objective: The occurrence of digestive complications especially upper gastrointestinal bleeding (UGIB) has increased after cardiac surgery. The aim of this study was to determine the incidence of UGIB and identify the independent risk factors. Materials and Methods: We retrospectively analyzed data of 1077 patients undergoing cardiopulmonary bypass (CPB) from 1994 to 2012 The group of patients with UGIB (n 1 = 20) was compared with the population group (n 2 = 1057). Demographic characteristics, therapeutic management, endoscopic findings, and outcomes were analyzed. Through a regression analysis we identified independent risk factors of UGIB. Results: The mean age of the group n 1 was 58.2 ± 12.4 years and 50.18 ± 13.5 years in the group n 2. UGIB occurred about 13 ± 5.5 days after cardiac surgery. Gastroduodenal ulcer was the most common etiology of hemorrhage (n = 13, 65%). Renal insufficiency, previous gastric ulcer, increased lactate concentration during CPB, prolonged mechanical ventilation, use of vasopressor drug and pulmonary infection was likely contributing factors in UGIB. Conclusion: UGIB following open cardiac surgery is most frequently secondary to gastroduodenal ulceration. Many determinant factors of bleeding are incriminated. Surgeons must be aware of these factors to avoid fatal complications.

 
  • References

  • 1 Suleiman MS, Zacharowski K, Angelini GD. Inflammatory response and cardioprotection during open-heart surgery: The importance of anaesthetics. Br J Pharmacol 2008;153:21-33.
  • 2 van der Voort PH, Zandstra DF. Pathogenesis, risk factors, and incidence of upper gastrointestinal bleeding after cardiac surgery: Is specific prophylaxis in routine bypass procedures needed? J Cardiothorac Vasc Anesth 2000;14:293-9.
  • 3 Egleston CV, Wood AE, Gorey TF, McGovern EM. Gastrointestinal complications after cardiac surgery. Ann R Coll Surg Engl 1993;75:52-6.
  • 4 Andersson B, Nilsson J, Brandt J, Höglund P, Andersson R. Gastrointestinal complications after cardiac surgery. Br J Surg 2005;92:326-33.
  • 5 D’Ancona G, Baillot R, Poirier B, Dagenais F, de Ibarra JI, Bauset R, et al. Determinants of gastrointestinal complications in cardiac surgery. Tex Heart Inst J 2003;30:280-5.
  • 6 Rockall TA, Logan RF, Devlin HB, Northfield TC. Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. Steering Committee and Members of the National Audit of Acute Upper Gastrointestinal Haemorrhage. BMJ 1995;311:222-6.
  • 7 Barkun A, Sabbah S, Enns R, Armstrong D, Gregor J, Fedorak RN, et al. The Canadian Registry on Nonvariceal Upper Gastrointestinal Bleeding and Endoscopy (RUGBE): Endoscopic hemostasis and proton pump inhibition are associated with improved outcomes in a real-life setting. Am J Gastroenterol 2004;99:1238-46.
  • 8 Bhat M, Larocque M, Amorim M, Herba K, Martel M, De Varennes B, et al. Prediction and prevention of upper gastrointestinal bleeding after cardiac surgery: A case control study. Can J Gastroenterol 2012;26:340-4.
  • 9 Amorim M, Barkun AN, Larocque M, Herba K, De Varennes B, Martel M. In-hospital nonvariceal upper gastrointestinal bleeding following cardiac surgery: Patient characteristics, endoscopic lesions and prognosis. Ulcers 2012;2012:1-5.
  • 10 Bolcal C, Iyem H, Sargin M, Mataraci I, Sahin MA, Temizkan V, et al. Gastrointestinal complications after cardiopulmonary bypass: Sixteen years of experience. Can J Gastroenterol 2005;19:613-7.
  • 11 Filsoufi F, Rahmanian PB, Castillo JG, Scurlock C, Legnani PE, Adams DH. Predictors and outcome of gastrointestinal complications in patients undergoing cardiac surgery. Ann Surg 2007;246:323-9.
  • 12 Khan JH, Lambert AM, Habib JH, Broce M, Emmett MS, Davis EA. Abdominal complications after heart surgery. Ann Thorac Surg 2006;82:1796-801.
  • 13 Aouifi A, Piriou V, Bastien O, Joseph P, Blanc P, Chiari P, et al. Severe digestive complications after cardiac surgery under cardiopulmonary bypass. Can J Anesth 1999;46:114-21.
  • 14 Aljarallah B, Wong W, Modry D, Fedorak R. Prevalence and outcome of upper gastrointestinal bleeding post-coronary artery bypass graft. Int J Health Sci (Qassim) 2008;2:69-76.
  • 15 Yilmaz AT, Arslan M, Demirkilç U, Ozal E, Kuralay E, Bingöl H, et al. Gastrointestinal complications after cardiac surgery. Eur J Cardiothorac Surg 1996;10:763-7.
  • 16 Taylor PC, Loop FD, Hermann RE. Management of acute stress ulcer after cardiac surgery. Ann Surg 1973;178:1-5.
  • 17 Zacharias A, Schwann TA, Parenteau GL, Riordan CJ, Durham SJ, Engoren M, et al. Predictors of gastrointestinal complications in cardiac surgery. Tex Heart Inst J 2000;27:93-9.
  • 18 Yoshida K, Matsumoto M, Sugita T, Nishizawa J, Matsuyama K, Tokuda Y, et al. Gastrointestinal complications in patients undergoing coronary artery bypass grafting. Ann Thorac Cardiovasc Surg 2005;11:25-8.
  • 19 Yamaguchi T, Muraoka R, Tatsuta N, Hikasa Y, Tobe T, Koie H, et al. Acute stress ulcer after cardiac surgery. Nihon Geka Hokan 1980;49:338-43.
  • 20 Soehendra N, Grimm H, Stenzel M. Injection of nonvariceal bleeding lesions of the upper gastrointestinal tract. Endoscopy 1985;17:129-32.
  • 21 Jayaprakash A, McGrath C, McCullagh E, Smith F, Angelini G, Probert C. Upper gastrointestinal haemorrhage following cardiac surgery: A comparative study with vascular surgery patients from a single centre. Eur J Gastroenterol Hepatol 2004;16:191-4.
  • 22 Christenson JT, Schmuziger M, Maurice J, Simonet F, Velebit V. Postoperative visceral hypotension the common cause for gastrointestinal complications after cardiac surgery. Thorac Cardiovasc Surg 1994;42:152-7.
  • 23 Rey JF, Monnot F, Lombart J, Sabatier M, Schmitt R, Arnulf JJ, et al. Endoscopic diagnosis and treatment of acute digestive bleeding in a cardiac surgical department. Acta Endoscopia 1983;13:109-13.
  • 24 Katz SE, Kornfeld DS, Harris PD, Yeoh CB. Acute gastrointestinal ulceration with open heart surgery and aortic valve disease. Surgeon 1972;72:438-42.
  • 25 Lebovics E, Lee SS, Dworkin BM, Heier SK, Casellas A, Reed G, et al. Upper gastrointestinal bleeding following open heart surgery. Predominant finding of aggressive duodenal ulcer disease. Dig Dis Sci 1991;36:757-60.
  • 26 Della Ratta RK, Corapi MJ, Horowitz BR, Calio AJ. Risk of postoperative upper gastrointestinal tract hemorrhage in patients with active peptic ulcer disease undergoing nonulcer surgery. Arch Intern Med 1993;153:2141-4.
  • 27 Geissler HJ, Fischer UM, Grunert S, Kuhn-Régnier F, Hoelscher A, Schwinger RH, et al. Incidence and outcome of gastrointestinal complications after cardiopulmonary bypass. Interactive Cardiovasc Thorac Surg 2006;5:239-42.
  • 28 Raja SG, Haider Z, Ahmed M. Predictors of gastrointestinal complications after conventional and beating heart coronary surgery. Surg J R Coll Surg Edinb Irel 2003;4:221-8.
  • 29 Croome KP, Kiaii B, Fox S, Quantz M, McKenzie N, Novick RJ. Comparison of gastrointestinal complications in on-pump versus off-pump coronary artery bypass grafting. Can J Surg 2009;52:125-8.
  • 30 Hata M, Shiono M, Sekino H, Furukawa H, Sezai A, Iida M, et al. Prospective randomized trial for optimal prophylactic treatment of the upper gastrointestinal complications after open heart surgery. Circ J 2005;69:331-4.
  • 31 Wagner BK, Amory DW, Majcher CM, DiFazio LT, Scott GE, Spotnitz AJ. Effects of intravenous famotidine on gastric acid secretion in patients undergoing cardiac surgery. Ann Pharmacother 1995;29:349-53.
  • 32 Tayama E, Hayashida N, Fukunaga S, Tayama K, Takaseya T, Hiratsuka R, et al. High-dose cimetidine reduces proinflammatory reaction after cardiac surgery with cardiopulmonary bypass. Ann Thorac Surg 2001;72:1945-9.
  • 33 Shin JS, Abah U. Is routine stress ulcer prophylaxis of benefit for patients undergoing cardiac surgery? Interact Cardiovasc Thorac Surg 2012;14:622-8.
  • 34 Spotnitz WD, Sanders RP, Hanks JB, Nolan SP, Tribble CG, Bergin JD, et al. General surgical complications can be predicted after cardiopulmonary bypass. Ann Surg 1995;221:489-96.
  • 35 Simić O, Strathausen S, Hess W, Ostermeyer J. Incidence and prognosis of abdominal complications after cardiopulmonary bypass. Cardiovasc Surg 1999;7:419-24.
  • 36 Recht MH, Smith JM, Woods SE, Engel AM, Hiratzka LF. Predictors and outcomes of gastrointestinal complications in patients undergoing coronary artery bypass graft surgery: A prospective, nested case-control study. J Am Coll Surg 2004;198:742-7.
  • 37 Perugini RA, Orr RK, Porter D, Dumas EM, Maini BS. Gastrointestinal complications following cardiac surgery. An analysis of 1477 cardiac surgery patients. Arch Surg 1997;132:352-7.
  • 38 Cheynel N, Peschaud F, Hagry O, Rat P, Ognois-Ausset P, Favre JP. Bleeding gastroduodenal ulcer: Results of surgical management. Ann Chir 2001;126:232-5.
  • 39 Loffroy R, Guiu B. Role of transcatheter arterial embolization for massive bleeding from gastroduodenal ulcers. World J Gastroenterol 2009;15:5889-97.
  • 40 Krasna MJ, Flancbaum L, Trooskin SZ, Fitzpatrick JC, Scholz PM, Scott GE, et al. Gastrointestinal complications after cardiac surgery. Surgery 1988;104:773-80.