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The Journal of Cardiovascular Surgery 2001 December;42(6):723-9

language: English

Effect of coronary artery bypass grafting with gastroepiploic artery on gastric intramucosal pH and systemic inflammation

Yamaura K., Akiyoshi K., Irita K., Takahashi S.

From ­the Department of Anesthesiology and Critical Care Medicine Graduate School of Medical Sciences Kyushu University, Fukuoka, Japan


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Background. The pur­pose of ­this ­study ­was to inves­ti­gate ­the ­effect of cor­o­nary arte­ri­al ­bypass graft­ing (CABG) ­with gas­troep­i­plo­ic ­artery (­GEA) on gas­tric intra­mu­co­sal pH ­and system­ic inflam­ma­tion.
Methods. Design: retrospective ­study. Setting: Univer-­sity hos­pi­tal. Participants: 22 ­patients ­under-­went ­CABG. Investigations: the ­GEA ­group (n=13) ­received ­CABG ­with ­the ­GEA ­graft. The ­non-­GEA ­group (n=9) ­received con­ven­tion­al ­CABG with­out ­the ­GEA ­graft. Measurements: gastric intra­mu­co­sal pH (pHi) ­and car­bon diox­ide ten­sion (PrCO2) ­were ­assessed by cap­no­met­ric ­air tonom­e­try. The dif­fer­ence ­between PrCO2 ­and PaCO2, ­PCO2-­gap, ­was ­also deter­mined. Systemic inflam­ma­to­ry respons­es ­were eval­u­at­ed by ser­um inter­leu­kin-6 (IL-6) ­and leu­co­cyte ­counts. Hemodynamics, oxy­gen deliv­ery ­index (D˙O2I) ­and ­uptake ­index (V˙O2I) ­were mon­i­tored ­with cath­e­ters in ­the radi­al ­and pul­mo­nary arter­ies (ther­mo­di­lu­tion).
Results. The dura­tion of aor­tic ­cross-clamp­ing ­and car­di­o­pul­mo­nary ­bypass ­was sim­i­lar in ­both ­groups. Both ­groups ­did ­not ­show ­any sig­nif­i­cant dif­fer­ence in gas­tric pHi, ­PCO2-­gap, system­ic inflam­ma­tion ­and hemo­dy­nam­ics.
Conclusions. Our find­ings sug­gest ­that ­CABG ­using ­the ­GEA ­graft ­does ­not dis­turb gas­tric muco­sal per­fu­sion, ­and ­that lap­a­rot­o­my ­for ­the ­GEA ­graft ­does ­not aggra­vate system­ic oxy­gen ­demand-sup­ply imbal­ance or system­ic inflam­ma­to­ry respons­es ­induced by hypo­ther­mic ­CPB. ­CABG ­with ­the ­GEA ­graft ­does ­not ­seem to ­pose an addi­tion­al ­risk ­and is a ­safe tech­nique com­pared ­with con­ven­tion­al ­CABG ­with ­regard to pHi ­and system­ic inflam­ma­tion.

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