HYPERAMYLASEMIA AFTER CARDIAC SURGERY IS NOT RELATED TO THE USE OF CARDIOPULMONARY BYPASS

Autor: Ahmed A. Arifi, Song Wan, A. P. C. Yim, T. W. Lee, C.S.Y. Chan, Iyp Wan
Rok vydání: 2001
Předmět:
Zdroj: Annals of the College of Surgeons of Hong Kong. 5:A21-A21
ISSN: 1442-2034
1028-4001
DOI: 10.1111/j.1442-2034.2001.98-24.x
Popis: Background: Although hyperamylasemia has been reported in a large proportion of patients undergoing cardiopulmonary bypass (CPB), its clinical significance as well as the pathogenic mechanism remain poorly understood. Apart from pancreatic cellular injury, impaired renal function or hypercalcemia after CPB was also proposed to play a possible role in the etiology of postoperative hyperamylasemia. The study was designed to investigate whether avoidance of CPB would limit amylase elevation. Methods: Serum levels of amylase and lipase were measured before operation, 24 and 48 hours after surgery in 58 patients undergoing elective coronary artery bypass grafting (CABG) with or without the use of CPB over a 10-month period. The choice of procedure was based mainly on the native coronary anatomy and left ventricular function. Postoperative complications as well as the plasma levels of creatinine and calcium were also carefully monitored. Results: Three surgical approaches were used for CABG: CPB (conventional on-pump through median sternotomy, n = 32), OPCAB (off-pump through median sternotomy, n = 14), and MIDCAB (off-pump through left minithoracotomy, n = 12). There was no hospital mortality. No patient had postoperative abdominal complications. Transient hyperamylasemia occurred in 14 patients, 7 in the CPB group (22%), 5 in the OPCAB group (36%), and 2 in the MIDCAB group (17%). The increase in amylase levels was similar among groups. However, no lipase elevation was detected in any patient. There was no clear correlation between hyperamylasemia and an increased creatinine level. Perioperative plasma calcium levels were normal in patients who had hyperamylasemia. Conclusion: There is no significant difference in the incidence of hyperamylasemia among patients undergoing myocardial revascularization with or without the use of CPB and irrespective of mode of surgical access. Hence, CPB is not the major factor responsible for hyperamylasemia, as previously believed.
Databáze: OpenAIRE
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