Document Detail


Splanchnic organ injury during coronary surgery with or without cardiopulmonary bypass: a randomized, controlled trial.
MedLine Citation:
PMID:  16368344     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: We investigated the efficacy of coronary surgery with or without cardiopulmonary bypass in protecting the function of the small intestine, liver, and pancreas. METHODS: Patients were randomized to off-pump coronary artery bypass grafting (OPCAB) or coronary artery bypass grafting with cardiopulmonary bypass (CABG-CPB). Small intestine function was assessed by differential four sugars (O = methyl-D-glucose, D-xylose, L-rhamnose, and lactulose) permeability and absorption tests. Liver function was assessed by monoethylglycinexylidide/lidocaine ratios and by serial measurements of transaminases (aspartate transaminase and alanine-amino transferase), bilirubin, and alkaline phosphatase. Pancreatic function was assessed by serial measurements of insulin/glucagon ratio, amylase, and glucose. Forty patients were recruited (20 per group). RESULTS: Permeability and absorption were more impaired in the OPCAB group immediately after surgery, but returned to baseline levels in both groups by postoperative day 5 (interaction of surgery type and time; p = 0.05 and p = 0.02, respectively). Monoethylglycinexylidide/lidocaine ratios were not different in the two groups. Aspartate transaminase and alanine-amino transferase levels were higher in the CABG-CPB group for the first postoperative day, but levels converged by day 3 (interaction of surgery type and time; p < 0.0001 and p = 0.04, respectively). The bilirubin level for the OPCAB group overshot the CABG-CPB group at 36 hours before returning to a similar level 60 hours postoperatively. Amylase levels were higher in the CABG-CPB group than in the OPCAB group (1.17 times; p = 0.03); other markers of pancreatic function showed no differences between the groups. CONCLUSIONS: Early small intestine function is worse with OPCAB; all functions recover to similar levels in both groups by day 5. Conversely, pancreatic function is worse with the CABG-CPB group than with the OPCAB group. Hepatic metabolic function does not differ by type of surgery to the end of the operation. Postoperative hepatocellular injury was worse with the CABG-CPB group.
Authors:
Raimondo Ascione; Sudath Talpahewa; Chanaka Rajakaruna; Barnaby C Reeves; A Timothy Lovell; Alan Cohen; Gianni D Angelini
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  81     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2006 Jan 
Date Detail:
Created Date:  2005-12-21     Completed Date:  2006-08-25     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  97-103     Citation Subset:  AIM; IM    
Affiliation:
Bristol Heart Institute, Bristol Royal Infirmary, Bristol, United Kingdom. r.ascione@bristol.ac.uk
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MeSH Terms
Descriptor/Qualifier:
Aged
Alanine Transaminase / blood
Amylases / blood
Aspartate Aminotransferases / blood
Blood Glucose / analysis
Carbohydrates / diagnostic use
Cardiopulmonary Bypass / adverse effects*
Coronary Artery Bypass / statistics & numerical data*
Coronary Artery Bypass, Off-Pump / statistics & numerical data
Female
Glucagon / blood
Humans
Insulin / blood
Intestinal Absorption
Intestinal Diseases / diagnosis,  epidemiology,  etiology*,  physiopathology
Intestine, Small / blood supply,  metabolism
Ischemia / diagnosis,  etiology,  physiopathology
Lidocaine / analogs & derivatives,  blood
Liver / blood supply,  physiopathology
Liver Diseases / diagnosis,  epidemiology,  etiology*,  physiopathology
Liver Function Tests
Male
Metabolic Detoxication, Drug
Middle Aged
Pancreas / blood supply,  physiopathology
Pancreatic Diseases / diagnosis,  epidemiology,  etiology*,  physiopathology
Postoperative Complications / diagnosis,  etiology*,  physiopathology
Risk
Splanchnic Circulation
Chemical
Reg. No./Substance:
0/Blood Glucose; 0/Carbohydrates; 11061-68-0/Insulin; 137-58-6/Lidocaine; 7728-40-7/monoethylglycinexylidide; 9007-92-5/Glucagon; EC 2.6.1.1/Aspartate Aminotransferases; EC 2.6.1.2/Alanine Transaminase; EC 3.2.1.-/Amylases

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