Is Malignancies Related Gastrointestinal Bleeding Safe for Cardiopulmonary Bypass Surgery? - A Case-control Study

Abstract

Abstract The aggravation risk of malignancies related gastrointestinal bleeding (M-GIB) after cardiac surgery under cardiopulmonary bypass (CPB) was unknown, our study aimed to demonstrate the risk to help clinical decision making under this complicated circumstance. 19 patients with preoperative M-GIB and underwent cardiac surgery with CPB constituted the exposed group. Up to 5 controls were matched for each exposed patient according to age, sex and surgery type and constituted the control group. We defined a seven-grade ordinal scale to assess the clinical severity of gastrointestinal bleeding (GIB). Pre-and post-operative GIB grade and other clinical endpoints were compared between the two groups. Among our cardiac surgery patients, M-GIB were caused mostly by TNM grade III gastrointestinal cancer. Antiplatelet drugs or anticoagulants were reduced preoperatively for 47.4% patients and postoperatively for 42.1% patients considering the risk of GIB. Although postoperative GIB grade was higher (P = 0.042) compared to the controls, we found no postoperative aggravation of GIB in the exposed group. After cardiac surgery, 89.5% patients underwent gastrointestinal surgery as scheduled. Although the priority of cardiac or gastrointestinal surgery for patients with cardiac surgical indication and M-GIB was difficult to decide, cardiac surgery didn’t increase the aggravation risk of M-GIB.