Gastrointestinal Complications and Their Management After Adult Cardiac Surgery

  • Jamel Ortoleva
  • Edward A. BittnerEmail author


Gastrointestinal complications (GICs) following cardiac surgery are often severe and contribute to substantial morbidity and mortality. The diagnosis of GICs remains difficult because symptoms and signs are often subtle, or nonspecific, and this commonly leads to delay in definitive diagnosis and treatment. Preventive strategies, coupled with early recognition and aggressive management, provide the foundation of the general clinical approach to addressing these complications. Overall, a high index of clinical suspicion and a low threshold for investigation and definitive management are recommended in patients with nonroutine clinical progress after cardiac surgery. It is imperative that all clinicians who care for postoperative cardiac surgical patients be familiar with the full spectrum of potential GICs in this patient population, as well as the general therapeutic approaches to these complications.


Gastrointestinal complications Risk factors Pathophysiology Epidemiology Ileus Colonic pseudo-obstruction Dysphagia Gastritis Esophagitis Gastrointestinal bleeding Acute cholecystitis Acute mesenteric ischemia Liver dysfunction Pancreatitis Gastrointestinal complications related to mechanical assist devices 


  1. Acosta S, Sonesson B, Resch T. Endovascular therapeutic approaches for acute superior mesenteric artery occlusion. Cardiovasc Intervent Radiol. 2009;32(5):896–905.CrossRefPubMedGoogle Scholar
  2. Allen SJ. Gastrointestinal complications and cardiac surgery. J Extra Corpor Technol. 2014;46:142–9.PubMedPubMedCentralGoogle Scholar
  3. Ashfaq A, Johnson DJ, Chapital AB, Lanza LA, DeValeria PA, Arabia FA. Changing trends in abdominal surgical complications following cardiac surgery in an era of advanced procedures. A retrospective cohort study. Int J Surg. 2015;15:124–8.CrossRefPubMedGoogle Scholar
  4. Cheng A, Williamitis CA, Slaughter MS. Comparison of continuous-flow and pulsatile-flow left ventricular assist devices: is there an advantage to pulsatility? Ann Cardiothorac Surg. 2014;3:573–81.PubMedPubMedCentralGoogle Scholar
  5. De Giorgio R, Knowles CH. Acute colonic pseudo-obstruction. Br J Surg. 2009;96:229–39.CrossRefPubMedGoogle Scholar
  6. Díaz-Gómez JL, Nutter B, Xu M, Sessler DI, Koch CG, Sabik J, Bashour CA. The effect of postoperative gastrointestinal complications in patients undergoing coronary artery bypass surgery. Ann Thorac Surg. 2010;90:109–15.CrossRefPubMedGoogle Scholar
  7. Dong G, Liu C, Xu B, Jing H, Li D, Wu H. Postoperative abdominal complications after cardiopulmonary bypass. J Cardiothorac Surg. 2012;7:108.CrossRefPubMedPubMedCentralGoogle Scholar
  8. Eris C, Yavuz S, Yalcinkaya S, Gucu A, Toktas F, Yumun G, Erdolu B, Ozyazicioglu A. Acute mesenteric ischemia after cardiac surgery: an analysis of 52 patients. ScientificWorldJournal. 2013;2013:631534.CrossRefPubMedPubMedCentralGoogle Scholar
  9. Fernandez-del Castillo C, Harringer W, Warshaw AL, Vlahakes GJ, Koski G, Zaslavsky AM, Rattner DW. Risk factors for pancreatic cellular injury after cardiopulmonary bypass. N Engl J Med. 1991;325:382–7.CrossRefPubMedGoogle Scholar
  10. 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(2):323–9.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Grimm JC, Magruder JT, Ohkuma R, Dungan SP, Hayes A, Vose AK, Orlando M, Sussman MS, Cameron DE, Whitman GJ. A novel risk score to predict dysphagia after cardiac surgery procedures. Ann Thorac Surg. 2015;100:568–74.CrossRefPubMedGoogle Scholar
  12. Gulkarov I, Trocciola SM, Yokoyama CC, Girardi LN, Krieger KK, Isom OW, Salemi A. Gastrointestinal complications after mitral valve surgery. Ann Thorac Cardiovasc Surg. 2014;20(4):292–8.CrossRefPubMedGoogle Scholar
  13. Guler A, Sahin MA, Atilgan K, Kurkluoglu M, Demirkilic U. A rare complication after coronary artery bypass graft surgery: Ogilvie’s syndrome. Cardiovasc J Afr. 2011;22:335–7.CrossRefPubMedGoogle Scholar
  14. Hessel EA 2nd. Abdominal organ injury after cardiac surgery. Semin Cardiothorac Vasc Anesth. 2004;8:243–63.CrossRefPubMedGoogle Scholar
  15. Karangelis D, Oikonomou K, Koufakis T, Tagarakis GI. Gastrointestinal complications following heart surgery: an updated review. Eur J Cardiovasc Med. 2011;1:34–7.Google Scholar
  16. Loffroy R, Favelier S, Pottecher P, Estivalet L, Genson PY, Gehin S, Cercueil JP, Krause D. Transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding: indications, techniques and outcomes. Diagn Interv Imaging. 2015;96:731–44.CrossRefPubMedGoogle Scholar
  17. Mangano DT. Aspirin and mortality from coronary bypass surgery. N Engl J Med. 2002;347:1309–17.CrossRefPubMedGoogle Scholar
  18. Mangi AA, Christison-Lagay ER, Torchiana DF, Warshaw AL, Berger DL. Gastrointestinal complications in patients undergoing heart operation: an analysis of 8709 consecutive cardiac surgical patients. Ann Surg. 2005;241:895–901; discussion 901–894.CrossRefPubMedPubMedCentralGoogle Scholar
  19. Mollhoff T, Loick HM, Van Aken H, Schmidt C, Rolf N, Tjan TD, Asfour B, Berendes E. Milrinone modulates endotoxemia, systemic inflammation, and subsequent acute phase response after cardiopulmonary bypass (CPB). Anesthesiology. 1999;90:72–80.CrossRefPubMedGoogle Scholar
  20. Moneta GL, Misbach GA, Ivey TD. Hypoperfusion as a possible factor in the development of gastrointestinal complications after cardiac surgery. Am J Surg. 1985;149:648–50.CrossRefPubMedGoogle Scholar
  21. Ohri SK, Velissaris T. Gastrointestinal dysfunction following cardiac surgery. Perfusion. 2006;21:215–23.CrossRefPubMedGoogle Scholar
  22. Passage J, Joshi P, Mullany DV. Acute cholecystitis complicating cardiac surgery: case series involving more than 16,000 patients. Ann Thorac Surg. 2007;83:1096–101.CrossRefPubMedGoogle Scholar
  23. Patel AJ, Som R. What is the optimum prophylaxis against gastrointestinal haemorrhage for patients undergoing adult cardiac surgery: histamine receptor antagonists, or proton-pump inhibitors? Interact Cardiovasc Thorac Surg. 2013;16:356–60.CrossRefPubMedGoogle Scholar
  24. Rastan AJ, Tillmann E, Subramanian S, Lehmkuhl L, Funkat AK, Leontyev S, Doenst T, Walther T, Gutberlet M, Mohr FW. Visceral arterial compromise during intra-aortic balloon counterpulsation therapy. Circulation. 2010;122:S92–9.CrossRefPubMedGoogle Scholar
  25. Rodriguez F, Nguyen TC, Galanko JA, Morton J. Gastrointestinal complications after coronary artery bypass grafting: a national study of morbidity and mortality predictors. J Am Coll Surg. 2007;205:741–7.CrossRefPubMedGoogle Scholar
  26. Sabzi F, Faraji R. Liver function tests following open cardiac surgery. J Cardiovasc Thorac Res. 2015;7:49–54.CrossRefPubMedPubMedCentralGoogle Scholar
  27. Slater JM, Orszulak TA, Cook DJ. Distribution and hierarchy of regional blood flow during hypothermic cardiopulmonary bypass. Ann Thorac Surg. 2001;72:542–7.CrossRefPubMedGoogle Scholar
  28. Vassiliou I, Papadakis E, Arkadopoulos N, Theodoraki K, Marinis A, Theodosopoulos T, Palatianos G, Smyrniotis V. Gastrointestinal emergencies in cardiac surgery. A retrospective analysis of 3,724 consecutive patients from a single center. Cardiology. 2008;111(2):94–101.CrossRefPubMedGoogle Scholar
  29. Viana FF, Chen Y, Almeida AA, Baxter HD, Cochrane AD, Smith JA. Gastrointestinal complications after cardiac surgery: 10-year experience of a single Australian centre. ANZ J Surg. 2013;83:651–6.CrossRefPubMedGoogle Scholar
  30. Yilmaz AT, Arslan M, Demirkilc U, Ozal E, Kuralay E, Bingol H, Oz BS, Tatar H, Ozturk OY. Gastrointestinal complications after cardiac surgery. Eur J Cardiothorac Surg. 1996;10:763–7.CrossRefPubMedGoogle Scholar
  31. Zhang G, Wu N, Liu H, Lv H, Yao Z, Li J. Case control study of gastrointestinal complications after cardiopulmonary bypass heart surgery. Perfusion. 2009;24:173–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Adult Cardiothoracic Anesthesiology ProgramYale-New Haven HospitalNew HavenUSA
  2. 2.Critical Care-Anesthesiology FellowshipMassachusetts General Hospital, Harvard Medical SchoolBostonUSA
  3. 3.Surgical Intensive Care UnitMassachusetts General Hospital, Harvard Medical SchoolBostonUSA
  4. 4.Department of Anesthesia, Critical Care and Pain MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonUSA

Personalised recommendations