Splanchnic Organ Injury During Coronary Surgery With or Without Cardiopulmonary Bypass: A Randomized, Controlled Trial

Ascione, Raimondo; Talpahewa, Sudath; Rajakaruna, Chanaka; Reeves, Barnaby C; Lovell, A.; Cohen, Alan M.; Angelini, Gianni

doi:10.1016/j.athoracsur.2005.06.038

Cited by 58 publications

(46 citation statements)

References 19 publications

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“…Lactate in the gut lumen is a marker of altered intestinal permeability [16], and in abdominal aortic surgery, elevated levels of lactate in the splanchnic circulation predict organ failure [13]. Our patients were chosen due to the known occurrence of altered permeability during CPB [1], and therefore we expected to detect increased levels of lactate in the gut lumen. They were not chosen from expectations of detecting serious intestinal ischaemia, which is very rare.…”

Section: Discussionmentioning

confidence: 99%

“…Combined with tonometry, microdialysis provides the opportunity to monitor both circulation and metabolism in the rectal mucosa. Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) are at risk of developing intestinal mucosal ischaemia, leading to disturbed mucosal integrity and increased intestinal permeability [1]. The latter may result in leakage of endotoxins into the circulation contributing to systemic inflammation observed during CPB [2].…”

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confidence: 99%

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Rectal lactate levels in endoluminal microdialysate during routine coronary surgery*

et al. 2007

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SummaryThe aim of this prospective study was to determine the feasibility of intestinal endoluminal microdialysis as a new method for clinical monitoring of the adequacy of splanchnic perfusion in the large bowel. A microdialysis catheter for continuous lactate, glycerol, glucose and pyruvate measurements attached to a tonometric catheter was placed into the lumen of the recto-sigmoid junction prior to surgery in 13 patients undergoing elective cardiac surgery with cardiopulmonary bypass (CPB). Lactate was also measured in blood and muscle. CPB was associated with a 10-fold increase in luminal lactate from 0.16 (0.01) to 1.67 (0.38) mmol.l )1 (p < 0.001). Muscular lactate increased from baseline levels 1.20 (0.21) to 1.77 (0.36) mmol.l )1 during CPB (p = 0.01), but the muscular lactate-pyruvate ratio remained unchanged. Arterial lactate increased only slightly from 0.9 (0.05) to 1.1 (0.06) mmol.l )1 (p = 0.027) during CPB. Increased lactate concentrations in the large bowel during CPB are suggestive of local lactate production consistent with impaired oxygen delivery. Intestinal endoluminal microdialysis is a potential clinically applicable method for monitoring intestinal metabolism. Combined with tonometry, microdialysis provides the opportunity to monitor both circulation and metabolism in the rectal mucosa. Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) are at risk of developing intestinal mucosal ischaemia, leading to disturbed mucosal integrity and increased intestinal permeability [1]. The latter may result in leakage of endotoxins into the circulation contributing to systemic inflammation observed during CPB [2]. The most likely cause of increased intestinal vascular permeability is imbalance between splanchnic oxygen supply and demand [3].There are currently few reliable methods available for monitoring adequacy of splanchnic perfusion during CPB. If available, these data could lead to strategies being developed to reduce intestinal ischaemia and the resulting increased mucosal permeability. Gastric tonometry is the only clinically available method that allows monitoring of gastro-intestinal perfusion. Even though in cardiac [4,5] and high-risk surgical patients [6] peri-operative tonometry-derived variables are predictive

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Rectal lactate levels in endoluminal microdialysate during routine coronary surgery*

et al. 2007

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“…al. (12) evaluated the effects of off-pump and on-pump CABG on the liver functions, and showed higher AST -ALT levels in the first postoperative day for on-pump group, but no difference in the monoethylglycinexylidide/ lidocaine ratio was seen. Yamada et.…”

Section: Discussionmentioning

confidence: 99%

On-Pump Cardiopulmonary Bypass Versus Off-Pump Coronary Artery Bypass Grafting Surgery: Renal And Liver Function Tests

Bayram

Zor

Erer

et al. 2016

GMJ

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Objective: Cardiopulmonary bypass (CPB) triggers systemic inflammation. Inflammatory system activation may cause deteoriation in liver and renal functions. In our study we aimed to search the effect of on-pump CPB and beating heart off-pump coronary artery bypass grafting (CABG) surgery techniques on renal and liver functions. Methods: Sixty four patients who underwent coronary artery surgery were included in the study and were divided into two groups: on-pump CPB group (40) and beating heart off-pump CABG group (24), prospectively. The blood samples were collected for preoperative and postoperative levels of blood urea nitrogen (BUN), creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and AST to ALT ratio at 24 th and 48 th hours. Results: Clinical and demographic features were similar in both groups. There were no statistically significant difference in levels of preoperative BUN, creatinine, AST, ALT, AST to ALT ratio. The postoperative 24 th hour plasma levels of creatinine, AST and AST/ALT were lower in beating heart off-pump CABG group but BUN and ALT levels were similar among the two groups. The postoperative 48 th hour plasma levels of BUN, creatinine, AST and AST/ALT were lower in beating heart off-pump CABG group but levels of ALT were similar in both groups. Conclusion: Based on our findings we conclude that beating heart off-pump CABG has lower negative effect on liver and renal function than on-pump CPB. Abstract of this manuscript was presented in 7th Congress of Update in Cardiology and Cardiovascular Surgery in association with TCT Mediterranean as a poster.Key Words: Acute kidney injury, cardiopulmonary bypass, coronary artery bypass, coronary artery bypass, off-pump, liver. Anahtar Sözcükler: Akut böbrek hasarı, kardiyopulmoner bypass, koroner arter bypass, off-pump koroner arter bypass graftleme, karaciğer. ReceivedGeliş Tarihi:

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“…During cardiac surgery with cardiopulmonary bypass (CPB), there is a high risk of patients developing intestinal mucosal ischemia. This may further lead to a disturbed mucosal integrity and increased intestinal permeability due to imbalance between splanchnic oxygen supply and demand which may contribute to systemic inflammation (48). Hence, an early diagnosis and the evaluation of an adequate splanchnic perfusion are crucial to improve outcome rates following surgical procedures such as aneurysm repair, anastomosis connections and CPB.…”

Section: Intestinal Ischemia and Its Role In Septic Shockmentioning

confidence: 99%

Microdialysis Monitoring of Biomarkers for Early Recognition of Intestinal Ischemia

Priya¹,

Córcoles²

2012

Sepsis - An Ongoing and Significant Challenge

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Splanchnic Organ Injury During Coronary Surgery With or Without Cardiopulmonary Bypass: A Randomized, Controlled Trial

Cited by 58 publications

References 19 publications

Rectal lactate levels in endoluminal microdialysate during routine coronary surgery*

Rectal lactate levels in endoluminal microdialysate during routine coronary surgery*

On-Pump Cardiopulmonary Bypass Versus Off-Pump Coronary Artery Bypass Grafting Surgery: Renal And Liver Function Tests

Microdialysis Monitoring of Biomarkers for Early Recognition of Intestinal Ischemia

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