Cardiopulmonary bypass complications and their predictors in open-heart surgery at a tertiary cardiac care facility in Tanzania

Abstract

Background

Cardiopulmonary bypass (CPB) is essential in open-heart surgery but is associated with systemic inflammatory response syndrome and organ-specific complications, which can worsen patient outcomes. In low-resource settings, limited local data may hinder targeted prevention strategies. We sought to assess the frequency and predictors of CPB-related complications in patients undergoing open-heart surgery in such settings, at a tertiary cardiac care facility in Tanzania.

Methods

A retrospective review was conducted at the Jakaya Kikwete Cardiac Institute, Tanzania, including pediatric and adult patients who underwent open-heart surgery between January and December 2020. Data from perfusion records and intensive care unit charts were analyzed. Descriptive statistics summarized patient characteristics, while χ² tests identified predictors of complications. Statistical significance was set at p < 0.05.

Results

Of 195 patients, 55.4% were male, 52.3% were under 15 years of age, and 3.1% underwent redo surgery. Valvular heart disease was the most common diagnosis (42.1%), and valvular replacement the most frequent procedure (37.4%). At least one major complication occurred in 31.3% of patients, with cardiovascular (10.8%) and bleeding (9.2%) events being most common. Prolonged intensive care unit stay occurred in 52.8% of cases, and mortality was 4.1%. Significant predictors of complications included younger age (p = 0.008), diagnosis type (p = 0.015), procedure type (p = 0.037), CPB duration (p = 0.009), and cross-clamp time (p < 0.001). CPB duration was specifically associated with cardiovascular (p = 0.035), renal (p = 0.032), and bleeding (p = 0.048) complications. Prolonged ICU stay was more likely with CPB time >120 minutes (52.3% vs 35.1%, p = 0.049).

Conclusions

CPB-related complications remain a major concern in open-heart surgery in Tanzania. Reducing CPB and cross-clamp durations, along with mitigating other identified risk factors, could improve outcomes and reduce ICU stays. Further locally driven research is warranted to refine management strategies in similar settings.