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Duodenal ulcers are a major cause of gastrointestinal
bleeding after cardiac surgery

Objective: To determine the incidence of gastrointestinal (GI) bleeding in patients
after cardiac surgery, assess the perioperative risk factors, and determine
.the type of GI tract pathology associated with bleeding events
Methods: At a tertiary referral hospital, all cardiac surgery patients having a postoperative
GI bleed from April 2002 to March 2012 were identified. To determine
.bleeding etiology, only patients requiring endoscopy were included in the analysis
By retrospective review of 3 prospectively maintained databases, the incidence
and independent predictors of GI bleeding, as well as endoscopic
.findings, were determined
Results: Ninety-one GI bleeding events that required endoscopy were identified
in 9017 patients. Those that bled were aged 71  12 years, and 76% were men
Sixty-three percent of these patients had valve surgery and 37% had an isolated
coronary artery bypass grafting. The overall incidence of GI bleeding was 1.01%
with an upper GI source accounting for 78%. Endoscopy data found a duodenal
ulcer as the bleeding source in 71%, whereas stress gastritis accounted for 8%
,Preoperative risk factors for bleeding included age 70 years, ejection fraction
<35%, congestive heart failure, cerebrovascular disease, chronic kidney disease
and gastrointestinal disease. A preoperative history of atrial fibrillation and anticoagulation
with Coumadin also was associated with bleeding. Patients that bled
had a 30-day mortality rate of 8.8%, which was significantly greater than patients
who did not bleed (4.3%; P ¼ .03)
Conclusions: Clinical variables can be used to identify patients at high risk for GI
bleeding after cardiac surgery. When GI bleeding occurs, the most common cause
is duodenal ulceration, which has an association with Helicobacter pylori infection
These findings may provide an opportunity to initiate preoperative preventative
(strategies. (J Thorac Cardiovasc Surg 2017;-:1-8

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