Plasma endotoxin concentrations during cardiac surgery may be related to atherosclerosis

Systemic endotoxemia develops during cardiopulmonary bypass, probably due to intestinal ischaemia. Differences in endotoxaemia among various cardiac operations and the relationship between endotoxemia and postoperative complications were studied in high-risk patients. Blood samples were obtained at termination of bypass in 136 adults undergoing elective cardiac surgery. Postoperative complications were registered prospectively. Plasma endotoxin was quantified by a kinetic limulus amebocyte lysate assay. Mean endotoxin concentrations were significantly lower in patients undergoing isolated valve replacement (89 ng/l) than in patients undergoing coronary artery bypass grafting alone (234 ng/l), or combined with valve replacement (278 ng/l) or carotid artery surgery (321 ng/l) (p < 0.05). In multivariate linear regression, only the number of grafts (0, 1-3, 4-5) was significantly correlated to endotoxin concentrations (p < 0.0005). Endotoxin concentrations were related to development of gastrointestinal dysfunction (p = 0.03), but not to mortality (p = 0.24) or other complications (p = 0.62).