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

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

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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