• Marco Rossi, Gabriele Sganga, Marinella Mazzone, Venanzio Valenza, Sergio Guarneri, Grazia Portale, Luigi Carbone, Lucia Gatta, Claudio Pioli, Maurizio Sanguinetti, Massimo Montalto, Franco Glieca, Giovanni Fadda, Rocco Schiavello, and Nicolò G Silveri.
• Department of Anesthesia, Unit of Cardiac Anesthesia, Università Cattolica del Sacro Cuore, Policlinico "A. Gemelli,", Rome, Italy. cardioanucsc@rm.unicatt.it
• Ann. Thorac. Surg. 2004 Feb 1; 77 (2): 612-8.

BackgroundCardiopulmonary bypass provokes a systemic inflammatory reaction that, in 1% to 2% of all cases, leads to multiorgan disfunction. The aim of this study was to evaluate the possible role of the intestine in the pathogenesis and development of this reaction.MethodsEleven selected patients scheduled for elective coronary artery bypass graft surgery were enrolled in a open, prospective clinical study. Gastric tonometry, chromium-labeled test and double sugar intestinal absorption tests, polymerase chain reaction microbial DNA test, and measurement of cytokines and transcriptional factor (nuclear factor kappaB) activation were performed.ResultsDuring the postoperative period, gastric pH remained stable (range,7.2 to 7.3). The partial pressure for carbon dioxide gradient between the gastric mucosa and arterial blood increased significantly (from 1 to 23 mm Hg), peaking in the sixth postoperative hour. Interleukin 6 increased significantly over basal levels, peaking 3 hours after cardiopulmonary bypass (96.3 versus 24 pg/mL). Nuclear factor kappaB never reached levels higher than those observed after lipopolysaccharide stimulation. Escherichia coli translocation was documented in 10 patients: in eight cases from removal of aortic cross-clamps and in two cases from the first postoperative hour. With respect to basal value (6.4%), the urine collection revealed a significant increase in excretion of the radioisotope during the first 24 hours after surgery (39.1%), although there were no significant variations with the double sugar test.ConclusionsThe results obtained showed a correlation between the damage of the gastrointestinal mucosa, subsequent increased permeability, E coli bacteremia, and the activation of a self-limited inflammatory response in the absence of significant macrocirculatory changes and postoperative complications.

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