Pancreatic complications following cardiopulmonary bypass. Factors influencing mortality
A. T. Lefor, P. Vuocolo, F. B. Parker Jr and L. F. Sillin
Department of Surgery, University of Maryland, Baltimore.
Pancreatic complications following cardiopulmonary bypass are infrequent
but are associated with high mortality. All cases of pancreatic
complications following cardiopulmonary bypass from 1972 to 1987 at a
single institution were retrospectively reviewed. Of 5621 patients who
underwent cardiopulmonary bypass, 25 (0.44%) sustained pancreatic
complications. There were 15 cases of acute pancreatitis and 10 cases of
pancreatic necrosis, with 11 deaths in the group reviewed, a mortality rate
of 44%. Factors that were correlated with mortality associated with
pancreatic complications in this study include preoperative hypotension,
preoperative use of inotropic agents, and renal failure (preoperative and
postoperative). Factors that have been previously associated with mortality
from pancreatic complications in other studies, such as fluid
sequestration, respiratory failure, sepsis, tachycardia, hypocalcemia, age
greater than 55 years, and abnormal laboratory findings, were not found to
be significantly associated with mortality in this study. Of the five
patients for whom complete data were available, not one patient received
greater than 800 mg of calcium per square meter of body surface area in the
perioperative period. While the exact mechanism of pancreatic injury
remains unclear, based on experimental studies and clinical correlation, it
is likely that pancreatic ischemia remains a significant contributing
factor. We conclude that no factor specifically associated with
cardiopulmonary bypass was correlated significantly with mortality.
