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Ann Thorac Surg 2004;77:612-618
© 2004 The Society of Thoracic Surgeons
a Department of Anesthesia, Unit of Cardiac Anesthesia, Rome, Italy
b Department of Surgery, Rome, Italy
c Department of Medicine, Rome, Italy
d ENEA, Section of Toxicology and Biomedicine, Rome, Italy
e Department of Microbiology, Rome, Italy
f Department of Nuclear Medicine, Rome, Italy
g Department of Cardiac Surgery, Università Cattolica del Sacro Cuore, Policlinico "A. Gemelli," Rome, Italy
Accepted for publication August 1, 2003.
* Address reprint requests to Dr Rossi, Department of Anesthesia, Università Cattolica del S. Cuore Policlinico A. Gemelli, largo A. Gemelli n.8, 00168 Rome, Italy
e-mail: cardioanucsc{at}rm.unicatt.it
BACKGROUND: Cardiopulmonary bypass provokes a systemic inflammatory reaction that, in 1% to 2% of all cases, leads to multiorgan disfunction. The aim of this study was to evaluate the possible role of the intestine in the pathogenesis and development of this reaction.
METHODS: Eleven selected patients scheduled for elective coronary artery bypass graft surgery were enrolled in a open, prospective clinical study. Gastric tonometry, chromium-labeled test and double sugar intestinal absorption tests, polymerase chain reaction microbial DNA test, and measurement of cytokines and transcriptional factor (nuclear factor 
B) activation were performed.
RESULTS: During the postoperative period, gastric pH remained stable (range,7.2 to 7.3). The partial pressure for carbon dioxide gradient between the gastric mucosa and arterial blood increased significantly (from 1 to 23 mm Hg), peaking in the sixth postoperative hour. Interleukin 6 increased significantly over basal levels, peaking 3 hours after cardiopulmonary bypass (96.3 versus 24 pg/mL). Nuclear factor B never reached levels higher than those observed after lipopolysaccharide stimulation. Escherichia coli translocation was documented in 10 patients: in eight cases from removal of aortic cross-clamps and in two cases from the first postoperative hour. With respect to basal value (6.4%), the urine collection revealed a significant increase in excretion of the radioisotope during the first 24 hours after surgery (39.1%), although there were no significant variations with the double sugar test.
CONCLUSIONS: The results obtained showed a correlation between the damage of the gastrointestinal mucosa, subsequent increased permeability, E coli bacteremia, and the activation of a self-limited inflammatory response in the absence of significant macrocirculatory changes and postoperative complications.
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