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CARDIOVASCULAR ANESTHESIA

Impairment of Hepatosplanchnic Oxygenation and Increase of Serum Hyaluronate During Normothermic and Mild Hypothermic Cardiopulmonary Bypass

Nobuhiro Okano, MD^*, Sotaro Miyoshi, MD^*, Ryoichi Owada, MD^*, Nao Fujita, MD^*, Yuji Kadoi, MD, Shigeru Saito, MD, Fumio Goto, MD, and Toshihiro Morita, MD^*

*Department of Anesthesiology, Saitama Cardiovascular and Pulmonary Center, Saitama, Japan; and Department of Anesthesiology and Reanimatology, Gunma University, School of Medicine, Gunma, Japan

Address correspondence and reprint requests to Nobuhiro Okano, Department of Anesthesiology, Saitama Cardiovascular and Pulmonary Center, 1696 Itai Konan-machi Osato-gun, Saitama 360-0105, Japan. Address e-mail to richard{at}ka2.so-net.ne.jp

Hepatic sinusoidal endothelial cells (SECs) are more vulnerable to hypoxia or hypothermia than hepatocytes. To test the hypothesis that hepatic venous desaturation during cardiopulmonary bypass (CPB) leads to impairment of SEC function, we studied the plasma kinetics of endogenous hyaluronate (HA), a sensitive indicator of SEC function, and hepatosplanchnic oxygenation during and after CPB. Twenty-five consecutive patients scheduled for elective coronary artery bypass graft surgery, who underwent normothermic (>35°C; n = 15) or mild hypothermic (32°C; n = 10) CPB participated in this study. A hepatic venous catheter was inserted into each patient to monitor hepatosplanchnic oxygenation and serum levels of HA concentration. Hepatic venous oxygen saturation decreased essentially to a similar degree during normothermic and mild hypothermic CPB. Hepatosplanchnic oxygen consumption and extraction increased during normothermic (P < 0.05), but not mild hypothermic, CPB. Both arterial and hepatic venous HA concentrations showed threefold increases during and after CPB in both groups. A positive correlation was found between hepatosplanchnic oxygen consumption and arterial HA concentrations during CPB, suggesting a role of changes in hepatosplanchnic oxygen metabolism in the mechanisms of increases in serum HA concentrations. The failure of the liver to increase HA extraction to a great degree suggests that a functional impairment of the SEC may contribute to the observed increase of serum HA.

IMPLICATIONS: Hepatic sinusoidal endothelial cells (SECs) are pivotal in the regulation of sinusoidal blood flow. This study showed that SEC function might be impaired during and after cardiopulmonary bypass, irrespective of the temperature management.

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