title: Effect of haemodynamic changes on epithelium-related intestinal injury in off-pump coronary surgery.
abstract: OBJECTIVE
  Intestinal injury is thought to play a central role in the occurrence of multiorgan dysfunction after on-pump coronary surgery. Clinical benefits of off-pump revascularisation remain, however, controversial.
  
  
  METHODS
  Hepatic enzymes and plasmatic IL-6, IL-8 and intestinal-type fatty acid binding protein (I-FABP) were determined in 20 patients (age 65-75) undergoing either on-pump (n = 10) or off-pump (n = 10) coronary surgery. Haemodynamic and biochemical parameters, catecholamine and volume therapy were monitored.
  
  
  RESULTS
  Central venous pressure (CVP) was significantly higher in the off-pump group during and 12h after operation (9.5 ± 1.35 vs. 6.21 ± 0.63 mmH2O, p = 0.012). Higher GGT and GLDH levels occurred in the off-pump group and correlated with the elevated I-FABP levels at 24h (935.8 ± 83.7 vs. 370.4 ± 67.7 pg/mL, p<0.001). CVP correlated with I-FABP peak values (Pearson's coefficient 0.852). IL-6 and IL-8 were released to a lower extent in the off-pump group compared to on pump (p<0.05) at 24h (139.3 ± 27.7 vs. 279.4 ± 56.2 and 15.3 ± 7.4 vs. 38.5 ± 13.8 pg/mL) and at 72 h post-operatively (4.5 ± 2.1 vs. 30.1 ± 12.1 and 7.8 ± 1.2 vs. 17.1 ± 5.2 pg/mL).
  
  
  CONCLUSIONS
  While inflammatory activation is reduced with CPB avoidance, elevated CVP during off-pump surgery is followed by temporary postoperative enterocyte damage that may threaten the normal function of the gastrointestinal system and lead - in certain groups of high risk patients--to irrecoverable injury.
authors: Department of Cardiac, Thoracic and Vascular Surgery, Johannes Gutenberg University Clinic, Mainz, Germany; Department of General, Visceral and Transplantation Surgery, University of Essen, Germany. Electronic address: terezia.andrasi@uk-essen.de.
authors: Terézia B
authors: TB
authors: Andrási
authors: Department of Cardiac, Thoracic and Vascular Surgery, Johannes Gutenberg University Clinic, Mainz, Germany.
authors: Florina
authors: F
authors: Mertens
authors: Department of Cardiac, Thoracic and Vascular Surgery, Johannes Gutenberg University Clinic, Mainz, Germany.
authors: Brigitta
authors: B
authors: Barabás
authors: Department of Pharmacognosy, Semmelweis University, Budapest, Hungary.
authors: Anna
authors: A
authors: Blázovics
mesh_terms: D000368:Aged; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects*; D050556:Fatty Acid-Binding Proteins / Q000097:blood; D005260:Female; D006439:Hemodynamics; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007410:Intestinal Diseases / Q000097:blood* / Q000209:etiology* / Q000473:pathology; D007413:Intestinal Mucosa / Q000293:injuries* / Q000473:pathology; D008297:Male; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: C508606:CXCL8 protein, human; D050556:Fatty Acid-Binding Proteins; C508600:IL6 protein, human; D015850:Interleukin-6; D016209:Interleukin-8; D005723:gamma-Glutamyltransferase; C554782:gamma-glutamyltransferase, human
keywords: Central venous pressure; Inflammation; Off-pump; Splanchnic ischaemia