Abstract • Hepatic dysfunction following cardiopulmonary bypass (CPB) is a relatively frequent finding, and jaundice occurring after CPB is associated with an increased mortality rate. PostCPB jaundice may be a consequence of inadequate liver perfusion during CPB. To evaluate the potential impact of CPB on effective hepatic blood flow, 10 patients undergoing CPB for cardiac procedures were studied. Effective hepatic blood flow was measured in each patient during the operative procedure but before institution of CPB and during CPB as well. Effective hepatic blood flow was measured by the galactose clearance technique. Blood lactate and pyruvate levels were also measured before and during CPB. During CPB, effective hepatic blood flow was consistently reduced by an average of 19%. Although for most patients this reduction seems well tolerated, in a minority of patients it may contribute to postoperative hepatic dysfunction. (Arch Surg. 1989;124:458-459) References 1. Collins JD, Ferner R, Murray A, et al. Incidence and prognostic importance of jaundice after cardiopulmonary bypass surgery . Lancet . 1983;1:1119-1123.Crossref 2. Kingsley DPE. Hepatic damage following profound hypothermia and extracorporeal circulation in man . Thorax . 1966;21:91-98.Crossref 3. Lockey E, McIntyre N, Ross DN, et al. Early jaundice after open heart surgery . Thorax . 1967;22:165-169.Crossref 4. Henderson JM, Kutner MH, Bain RP. First order clearance of plasma galactose: the effect of liver disease . Gastroenterology . 1982;83:1090-1096. 5. Henderson JM, Fales FW. Continuous flow fluorometry of low galactose concentrations in blood or plasma . Clin Chem . 1983;26:129-132. 6. Sanderson RG, Ellison JH, Benson JA, et al. Jaundice following open heart surgery . Ann Surg . 1967;165:217-224.Crossref 7. Lees MH, Herr RH, Hill JD, et al. Distribution of systemic blood flow of the rhesus monkey during cardiopulmonary bypass . J Thorac Cadiovasc Surg . 1971;61:570-586. 8. Waldhausen JA, Lombardo CR, McFarland JA, et al. Studies of hepatic blood flow and oxygen consumption during total cardiopulmonary bypass . Surgery . 1959;46:1118-1127. 9. Schenk WG, McDonald JC, McDonald K, et al. Direct measurement of hepatic blood flow in surgical patients . Ann Surg . 1962;156:463-471.Crossref 10. Schirmer WJ, Townsend MC, Schirmer JM, et al. Galactose clearance as an estimate of effective hepatic blood flow: validations and limitations . J Surg Res . 1986;41:543-556.Crossref 11. Townsend MC, Hampton WW, Haybron DM, et al. Effective organ blood flow and bioenergy status in murine peritonitis . Surgery . 1986;100:205-213. 12. Anderson MN, Norberg B, Senning A. Studies of liver function during extracorporeal circulation with low flow rate . Surgery . 1958;43:397-407.
Archives of Surgery – American Medical Association
Published: Apr 1, 1989
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