HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Taggart, D. P. Articles by Wheatley, D. J. Search for Related Content PubMed PubMed Citation Articles by Taggart, D. P. Articles by Wheatley, D. J.

The Annals of Thoracic Surgery, Vol 57, 376-382, Copyright © 1994 by The Society of Thoracic Surgeons

ARTICLES

Endotoxemia, complement, and white blood cell activation in cardiac surgery: a randomized trial of laxatives and pulsatile perfusion

DP Taggart, S Sundaram, C McCartney, A Bowman, H McIntyre, JM Courtney and DJ Wheatley
Department of Cardiac Surgery, Royal Infirmary Glasgow, United Kingdom.

Endotoxin activates complement and white blood cells and all are implicated in the pathologic effects of cardiopulmonary bypass (CPB). We investigated if reduction in intestinal bacterial load with a laxative and/or pulsatile perfusion to improve bowel circulation during CPB reduced endotoxemia and complement and white blood cell activation. Sixty patients were randomized to four groups in a 2 x 2 factorial structure: group 1 (no laxative, nonpulsatile perfusion); group 2 (laxative, nonpulsatile perfusion); group 3 (no laxative, pulsatile perfusion); and group 4 (laxative, pulsatile perfusion). Plasma concentrations of endotoxin, C3a and C5a, and granulocyte elastase (GE) were measured before anesthesia, skin incision, and heparin administration; during CPB (1, 30, 60, 90, and 120 minutes and after protamine administration); and after CPB at 3, 6, 12, 24, and 48 hours and 7 days. In all groups there was a small increase in the concentration of endotoxin (overall from 6 ng/L before CPB to 11 ng/L at 90 to 120 minutes; p < 0.001) and significant increases in C3a, C5a, and GE levels but no significant differences among the groups. Endotoxin levels did not correlate with activation of complement or white blood cells. There was a weak correlation between duration of CPB and levels of C3a (r = 0.14; p < 0.03) and GE (r = 0.25; p = 0.001) but not endotoxin or C5a. There was a general correlation between levels of C3a and GE but not in individual patients. In conclusion, CPB results in statistically significant increases in endotoxin, C3a, C5a, and GE during CPB.(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				L. Balacumaraswami, Y. Abu-Omar, J. Selvanayagam, D. Pigott, and D. P. Taggart The effects of on-pump and off-pump coronary artery bypass grafting on intraoperative graft flow in arterial and venous conduits defined by a flow/pressure ratio J. Thorac. Cardiovasc. Surg., March 1, 2008; 135(3): 533 - 539. [Abstract] [Full Text] [PDF]

				J. W. Hammon Extracorporeal Circulation: The Response of Humoral and Cellular Elements of Blood to Extracorporeal Circulation Card. Surg. Adult, January 1, 2008; 3(2008): 370 - 389. [Full Text]

				N. B. Aydin, H. Gercekoglu, B. Aksu, V. Ozkul, T. Sener, I. Kiygil, T. Turkoglu, S. Cimen, F. Babacan, and M. Demirtas Endotoxemia in coronary artery bypass surgery: A comparison of the off-pump technique and conventional cardiopulmonary bypass J. Thorac. Cardiovasc. Surg., April 1, 2003; 125(4): 843 - 848. [Abstract] [Full Text] [PDF]

				P. Menasche and L. H. Edmunds Jr. Extracorporeal Circulation: The Inflammatory Response Card. Surg. Adult, January 1, 2003; 2(2003): 349 - 360. [Full Text]

				F.-U. Sack, B. Reidenbach, A. Schledt, R. Dollner, S. Taylor, M. M. Gebhard, and S. Hagl Dopexamine attenuates microvascular perfusion injury of the small bowel in pigs induced by extracorporeal circulation Br. J. Anaesth., June 1, 2002; 88(6): 841 - 847. [Abstract] [Full Text] [PDF]

				P. Tassani, A. Barankay, F. Haas, S. U. Paek, M. Heilmaier, J. Hess, R. Lange, and J. A. Richter Cardiac surgery with deep hypothermic circulatory arrest produces less systemic inflammatory response than low-flow cardiopulmonary bypass in newborns J. Thorac. Cardiovasc. Surg., April 1, 2002; 123(4): 648 - 654. [Abstract] [Full Text] [PDF]

				D. Paparella, T.M. Yau, and E. Young Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update Eur. J. Cardiothorac. Surg., February 1, 2002; 21(2): 232 - 244. [Abstract] [Full Text] [PDF]

				G. J. Despotis and L. T. Goodnough Management approaches to platelet-related microvascular bleeding in cardiothoracic surgery Ann. Thorac. Surg., August 1, 2000; 70(2): S20 - 32. [Abstract] [Full Text] [PDF]

				D. P. Taggart Respiratory dysfunction after cardiac surgery: effects of avoiding cardiopulmonary bypass and the use of bilateral internal mammary arteries Eur. J. Cardiothorac. Surg., July 1, 2000; 18(1): 31 - 37. [Abstract] [Full Text] [PDF]

				S. Wan, J.-L. LeClerc, C.-H. Huynh, D. Schmartz, J.-M. DeSmet, A. P.C. Yim, and J.-L. Vincent DOES STEROID PRETREATMENT INCREASE ENDOTOXIN RELEASE DURING CLINICAL CARDIOPULMONARY BYPASS? J. Thorac. Cardiovasc. Surg., May 1, 1999; 117(5): 1004 - 1008. [Abstract] [Full Text] [PDF]

				E. Silistreli, H. Catalyurek, N. Sariosmanoglu, U. Acikel, E. Hazan, and O. Oto Effects on the Endocrine System of Pulsatile and Nonpulsatile Perfusion in Heart Surgery Asian Cardiovasc Thorac Ann, March 1, 1999; 7(1): 18 - 22. [Abstract] [Full Text] [PDF]

				E. M. Boyle Jr, T. H. Pohlman, M. C. Johnson, and E. D. Verrier Endothelial Cell Injury in Cardiovascular Surgery: The Systemic Inflammatory Response Ann. Thorac. Surg., January 1, 1997; 63(1): 277 - 284. [Abstract] [Full Text]

				M. Miyama, W. C. Dihmis, P. H. Deleuze, Y. Uozaki, S. L. Bambang, F. Pasteau, N. Rostaqui, and D. Y. Loisance The Gastrointestinal Tract: An Underestimated Organ as Demonstrated in an Experimental LVAD Pig Model Ann. Thorac. Surg., March 1, 1996; 61(3): 817 - 822. [Abstract] [Full Text]

				P. Hornick and A. George Blood contact activation: pathophysiological effects and therapeutic approaches Perfusion, January 1, 1996; 11(1): 3 - 19. [PDF]

				C. T Bowles, S. K Ohri, N. Klangsuk, B. E Keogh, M. H Yacoub, and K. M Taylor Endotoxaemia detected during cardiopulmonary bypass with a modified Limulus amoebocyte lysate assay Perfusion, July 1, 1995; 10(4): 219 - 228. [Abstract] [PDF]