title: Hepatopancreaticobiliary Values after Thoracoabdominal Aneurysm Repair.
abstract: BACKGROUND
  After thoracoabdominal aortic aneurysm (TAAA) repair, blood tests assessing hepatopancreaticobiliary (HPB) organs commonly have abnormal results. The clinical significance of such abnormalities is difficult to determine because the expected postoperative levels have not been characterized. Therefore, we sought to establish expected trends in HPB laboratory values after TAAA repair.
  
  
  METHODS
  This 5-year study comprised 155 patients undergoing elective Crawford extent II TAAA repair. In accordance with a prospective study protocol, all repairs involved left-sided heart bypass, selective visceral perfusion, and cold renal perfusion. Blood levels of aspartate transaminase (AST), alanine transaminase (ALT), γ-glutamyl transpeptidase (GGT), lactate dehydrogenase (LDH), total bilirubin, amylase, and lipase were measured before TAAA repair and for 7 days afterward. Ratios between postoperative and baseline levels were compared for each time point with 95% confidence intervals.
  
  
  RESULTS
  Temporal patterns for the laboratory values varied greatly. Amylase, lipase, and AST underwent significant early increases before decreasing to preoperative levels. LDH increased immediately and remained significantly elevated, whereas ALT increased more gradually. GGT remained near baseline through postoperative day 4, and then increased to more than twice baseline. Total bilirubin never differed significantly from baseline. After adjusted analysis, the ischemic time predicted the maximum AST, lipase, GGT, and LDH values.
  
  
  CONCLUSIONS
  Although most HPB laboratory values increase significantly after elective TAAA repair, the temporal trends for different values vary substantially. The ischemic time predicts the maximum AST, lipase, GGT, and LDH levels. These trends should be considered when laboratory values are assessed after TAAA repair.
authors.forename: Darrell
authors.initials: D
authors.lastname: Wu
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Coselli
authors.affiliation: University of Houston, College of Pharmacy, Department of Clinical Sciences and Administration, Division of Pharmacy Administration and Public Health, Houston, Texas.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Johnson
authors.forename: Scott A
authors.initials: SA
authors.lastname: LeMaire
keywords: Alanine transaminase; Aspartate transaminase; Hepatopancreaticobiliary function; Laboratory values; Thoracoabdominal aortic aneurysm