title: 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).
authors.affiliation: Department of Surgery A, Institute for Surgical Research. vibeke.videm@medisin.ntnu.
authors.forename: V
authors.initials: V
authors.lastname: Videm
authors.forename: J L
authors.initials: JL
authors.lastname: Svennevig
authors.forename: E
authors.initials: E
authors.lastname: Fosse
authors.forename: B
authors.initials: B
authors.lastname: Mohr
authors.forename: A O
authors.initials: AO
authors.lastname: Aasen
mesh_terms: D000368:Aged; D001161:Arteriosclerosis / Q000097:blood / Q000209:etiology*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002339:Carotid Arteries / Q000601:surgery; D004731:Endotoxins / Q000097:blood*; D005260:Female; D005767:Gastrointestinal Diseases / Q000097:blood / Q000209:etiology; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006801:Humans; D007511:Ischemia / Q000097:blood / Q000150:complications / Q000209:etiology; D008033:Limulus Test; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000097:blood*; D011446:Prospective Studies
chemical_list: D004731:Endotoxins