Kurt Muhammed, Litmathe Jens, Roehrborn Ansgar, Feindt Peter, Boeken Udo, Gams Emmeran
Department of Thoracic and Cardiovascular Surgery Heinrich-Heine-University Duesseldorf, Germany.
Acta Cardiol. 2006 Jun;61(3):301-6. doi: 10.2143/AC.61.3.2014832.
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.
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.
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.
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.
心脏直视手术后的腹部并发症仍然是严重事件，据报道死亡率极高。临床表现、诊断策略和治疗管理各不相同。我们回顾了过去五年中出现腹部并发症且有手术后果的患者的所有记录，进行了完整的随访，并将结果与当前的文献观点进行了比较。
1998年1月至2002年12月期间，共有5720例患者在我院接受了心脏直视手术。其中12例（10例男性，2例女性）出现了严重的胃肠道并发症并伴有手术后果。平均年龄为73.17±8.11岁。7例患者接受了单纯冠状动脉旁路移植术（CABG），2例患者接受了主动脉瓣置换术（AVR）和CABG联合手术，1例接受了单纯AVR，1例接受了二尖瓣置换术（MVR），还有1例接受了MVR和CABG联合手术。检查了所有这些患者的临床记录并进行了完整的随访。
整个心脏手术的持续时间平均为212.67±36.97分钟，灌注时间为103±29.32分钟，心肌缺血时间为52.25±24.56分钟。心脏手术后在重症监护病房（ICU）的停留时间为1至5天。关于胃肠道并发症，9例患者患有缺血性肠病，2例患者患有胃肠道溃疡出血，1例患者患有术前未知的肠道肿瘤并随后出现肠梗阻。4例患者在术后即刻死亡，1例患者在两年内死亡，7例患者在随访时状况良好。
文献综述显示心脏直视手术后腹部并发症的死亡率极高。我们的系列研究中也发现了这一点。由于这些患者中有许多人有腹部疾病史，在心脏手术前的准备过程中应更加关注此类既往史提示。因此，我们建议对有阳性既往史的患者在可疑情况下采取早期诊断措施并进行剖腹探查。
