Plasma endotoxin concentrations during cardiac surgery may be related to atherosclerosis

Abstract

Systemic endotoxemia develops during cardiopulmonary bypass, probably due to intestinal ischaemia. Differences in endotoxaemia among various cardiac operations and the relationship between endotoxemia and postoperative complications were studied in high-risk patients. Blood samples were obtained at termination of bypass in 136 adults undergoing elective cardiac surgery. Postoperative complications were registered prospectively. Plasma endotoxin was quantified by a kinetic limulus amebocyte lysate assay. Mean endotoxin concentrations were significantly lower in patients undergoing isolated valve replacement (89 ng/l) than in patients undergoing coronary artery bypass grafting alone (234 ng/l), or combined with valve replacement (278 ng/l) or carotid artery surgery (321 ng/l) (p < 0.05). In multivariate linear regression, only the number of grafts (0, 1-3, 4-5) was significantly correlated to endotoxin concentrations (p < 0.0005). Endotoxin concentrations were related to development of gastrointestinal dysfunction (p = 0.03), but not to mortality (p = 0.24) or other complications (p = 0.62).

Get full access to this article

View all access options for this article.

References

Naess F , Roise O , Pillgram-Larsen J , Ruud TE , Stadaas JO , Aasen AO. Plasma kallikrein generation in endotoxemia is abolished by ultra high doses of methyl-prednisolone: in vivo studies in a pig model . Circ Shock 1991; 34: 349-355 .

Rocke DA , Gaffin SL , Wells MT , Koen Y , Brock-Utine JG. Endotoxemia associated with cardiopulmonary bypass . J Thorac Cardiovasc Surg 1987; 93: 832-887 .

Martinez-Pellus AE , Merino P , Bru M et al. Can selective digestive decontamination avoid the endotoxemia and cytokine activation promoted by cardiopulmonary bypass ? Crit Care Med 1993; 21: 1684-1691 .

Andersen LW , Landow L , Baek L , Jansen E , Baker S. Association between gastric intramucosal pH and splanchnic endotoxin, antibody to endotoxin, and tumor necrosis factor-alpha concentrations in patients undergoing cardiopulmonary bypass . Crit Care Med 1993; 21: 210-217 .

Jansen PG , Te Velthuis H , Oudemans van Straaten HM et al. Perfusion-related factors of endotoxin release during cardiopulmonary bypass . Eur J Cardiothorac Surg 1994; 8: 125-129 .

Gercekoglu H , Tarim O , Agar I et al. Effects of hypothermia on blood endogenous endotoxin levels during cardiopulmonary bypass . J Card Surg 1997; 12: 223-227 .

Berendes E , Mollhoff T , Aken HV , Erren M , Deng MC , Loick HM. Increased plasma concentrations of serum amyloid A: an indicator of the acute-phase response after cardiopulmonary bypass . Crit Care Med 1997; 25: 1527-1533 .

Bowles CT , Ohri SK , Klangsuk N , Keogh BE , Yacoub MH , Taylor KM. Endotoxaemia detected during cardiopulmonary bypass with a modified Limulus amoebocyte lysate assay . Perfusion 1995; 10: 219-228 .

Berger D , Bolke E , Huegel H , Seidelmann M , Hannekum A , Beger HG. New aspects concerning the regulation of the post-operative acute phase reaction during cardiac surgery . Clin Chim Acta 1995; 239: 121-130 .

10.

Videm V , Mollnes TE , Fosse E et al. Heparin-coated cardiopulmonary bypass: I. Biocompatibility markers and development of complications in a high-risk population . J Thorac Cardiovasc Surg 1999; 117: 794-802 .

11.

Higgins TL , Estafanous FG , Loop FD , Beck GJ , Blum JM , Paranandi L. Stratification of morbidity and mortality outcome by preoperative risk factors in coronary artery bypass patients . JAMA 1992; 265: 2344-2348 .

12.

Ohri SK , Becket J , Brannan J , Keogh BE , Taylor KM. Effects of cardiopulmonary bypass on gut blood flow, oxygen utilization, and intramucosal pH . Ann Thorac Surg 1994; 57: 1193-1199 .

13.

Riddington DW , Venkatesh B , Boivin CM et al. Intestinal permeability, gastric intramucosal pH, and systemic endotoxemia in patients undergoing cardiopulmonary bypass . JAMA 1996; 275: 1007-1012 .

14.

Khabar KS , el Barbary MA , Khouqeer F , Devol E , al Gain S , al Halees Z. Circulating endotoxin and cytokines after cardiopulmonary bypass: differential correlation with duration of bypass and systemic inflammatory response/multiple organ dysfunction syndromes . Clin Immunol Immunopathol 1997; 85: 97-103 .

15.

Myles P , Buckland M , Cannon G et al. The association among gastric mucosal pH, endotoxemia, and low systemic vascular resistance after cardiopulmonary bypass . J Cardiothorac Vasc Anesth 1996; 10: 195-200 .

16.

Nilsson L , Kulander L , Nyström SO , Eriksson O. Endotoxins in cardiopulmonary bypass . J Thorac Cardiovasc Surg 1990; 100: 777-780 .

17.

Andersen LW , Baek L , Degn H , Lehd J , Krasnik M , Rasmussen JP. Presence of circulating endotoxins during cardiac operations . J Thorac Cardiovasc Surg 1987; 93: 115-119 .

18.

Brandtzæg P , Kierulf P , Baustad P et al. Plasma endotoxin as a predictor of multiple organ failure and death in systemic meningococcal disease . J Infect Dis 1989; 159: 195-204 .

19.

Imai T , Shiga T , Saruki N , Nishikawa K , Fujita T , Morishita Y. Change in plasma endotoxin titres and endotoxin neutralizing activity in the perioperative period . Can J Anaesth 1996; 43: 812-819 .