Visceral injury and systemic inflammation in patients undergoing extracorporeal circulation during aortic surgery.
OBJECTIVE
Visceral injury and inflammation are evaluated in patients undergoing extracorporeal circulation (ECC) either with distal aortic perfusion (DAP) during thoracic aortic aneurysm (TAA) repair or DAP and selective organ perfusion (DAP and SP) during thoracoabdominal aortic aneurysm (TAAA) repair.


BACKGROUND
Visceral hypoperfusion and subsequent visceral injury, mainly to the gut, have been implicated as central events in the development of systemic inflammatory response syndrome (SIRS) and organ dysfunction after major surgery. Patients undergoing DAP or DAP and SP are exposed to artificial visceral perfusion, potentially leading to the development of intestinal injury and systemic inflammation.


METHODS
To assess visceral injury arteriovenous differences of fatty acid binding proteins were measured for the gut (I-FABP and L-FABP) and left kidney (L-FABP) along with systemic plasma concentrations. Systemic ALT was used as liver injury marker. Plasma IL-6 and IL-8 denoted systemic inflammation.


RESULTS
During ECC systemic I-FABP and L-FABP levels increased in both groups, representing intestinal injury. Significantly elevated levels of I-FABP (P < 0.001) and L-FABP (P < 0.001) were found in the DAP and SP group, after ECC was stopped and normal circulation restored. Liver and renal tubular cell injury was not detected. Significant increases in systemic IL-6 and IL-8 values were measured only in patients undergoing DAP and SP. Additionally, the extent of intestinal injury correlated positively with systemic inflammation.


CONCLUSIONS
This study shows the development of intestinal mucosal injury during ECC with DAP or DAP and SP, indicative of insufficient intestinal perfusion. Intestinal injury was associated with a systemic pro-inflammatory response.
Hanssen
Sebastiaan J
SJ
European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital Aachen. [corrected]
Derikx
Joep P
JP
Vermeulen Windsant
Iris C
IC
Heijmans
John H
JH
Koeppel
Thomas A
TA
Schurink
Geert Willem
GW
Buurman
Wim A
WA
Jacobs
Michael J
MJ
D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019540:Area Under Curve; D005112:Extracorporeal Circulation; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007413:Intestinal Mucosa / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood; D014781:Viscera / Q000098:blood supply / Q000293:injuries*
C493319:FABP1 protein, human; D050556:Fatty Acid-Binding Proteins; D015850:Interleukin-6; D016209:Interleukin-8