Bacterial translocation secondary to small intestinal mucosal ischemia during cardiopulmonary bypass. Measurement by diamine oxidase and peptidoglycan.
OBJECTIVE
To demonstrate that small intestinal mucosal ischemia occurs during cardiopulmonary bypass by measuring serum diamine oxidase activity, an index of small intestinal mucosal ischemia, in perioerative patients undergoing cardiovascular surgery with and without cardiopulmonary bypass.


METHODS
Twelve successive patients who underwent coronary artery bypass grafting with cardiopulmonary bypass (Group I) were compared to 10 patients who underwent off-pump coronary artery bypass grafting (Group II). Serum diamine oxidase activity, blood lactate concentration, and serum peptidoglycan concentration were measured perioperatively.


RESULTS
Serum diamine oxidase activity rose after the start of cardiopulmonary bypass and continued to rise throughout cardiopulmonary bypass in Group I, while activity was unchanged in Group II. The serum lactate concentration mirrored the change in the diamine oxidase activity in both groups. The peptidoglycan concentration in Group I rose after the start of cardiopulmonary bypass and returned to near normal concentrations after surgery.


CONCLUSIONS
The parallel rise in diamine oxidase activity and the serum lactate concentration in Group I implies that ischemic injury to the mucosa of the small intestine occurs during cardiopulmonary bypass, and the rise in the serum peptidoglycan concentration indicates that bacteremia did occur. Thus, cardiopulmonary bypass causes hypoperfusion of small intestinal mucosa and consequently bacterial translocation.
Tsunooka
Nobuo
N
Second Department of Surgery, Ehime University School of Medicine, Shitsukawa, Shigenobucho, Onsengun, 791-0295, Ehime, Japan. tsunooka@m.ehime-u.ac.jp
Maeyama
Kazutaka
K
Hamada
Yoshihiro
Y
Imagawa
Hiroshi
H
Takano
Shinji
S
Watanabe
Yuji
Y
Kawachi
Kanji
K
D000368:Aged; D000369:Aged, 80 and over; D006631:Amine Oxidase (Copper-Containing) / Q000097:blood; D016470:Bacteremia / Q000175:diagnosis / Q000209:etiology*; D018988:Bacterial Translocation; D015415:Biomarkers / Q000097:blood; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000098:blood supply; D007421:Intestine, Small / Q000098:blood supply* / Q000382:microbiology; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology*; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D010457:Peptidoglycan / Q000097:blood
D015415:Biomarkers; D010457:Peptidoglycan; D019344:Lactic Acid; D006631:Amine Oxidase (Copper-Containing)