Barrier function of the gut and multiple organ dysfunction after cardiac surgery

Area of Science:

• Gastroenterology
• Cardiology
• Critical Care Medicine

Background:

• Cardiopulmonary bypass (CPB) in cardiac surgery can lead to multiple organ dysfunction (MOD).
• The gastrointestinal (GI) tract's role in MOD development post-CPB requires further investigation.
• Assessing GI mucosal integrity may offer predictive insights into post-surgical complications.

Purpose of the Study:

• To investigate the influence of sequential gastrointestinal tract involvement on MOD development following CPB.
• To determine if pre-operative GI mucosal function can predict MOD occurrence after cardiac surgery.
• To correlate peri-operative endotoxin core antibody (EndoCAb) levels with MOD development.

Main Methods:

• Prospective observational study of 146 patients undergoing elective cardiac surgery.
• Standardized oral inert-sugar tests (sucrose, lactulose, mannitol, sucralose) performed pre- and post-CPB.
• Enzyme-linked immunosorbent assay (ELISA) for plasma EndoCAb levels; functional mucosal surface calculated from mannitol absorption.

Main Results:

• Lower pre-operative urine mannitol concentrations (indicating reduced functional mucosal surface) were observed in patients who developed MOD.
• Reduced pre-operative mannitol absorption was an independent predictor of MOD in binary logistic regression.
• Decreased post-operative plasma EndoCAb levels were more significant in patients developing MOD.

Conclusions:

• A reduced pre-operative functional mucosal surface of the gastrointestinal tract may predict the early occurrence of MOD after cardiopulmonary bypass.
• Assessing GI mucosal integrity pre-operatively is a potential strategy for identifying patients at higher risk for post-cardiac surgery MOD.
• Endotoxin core antibody levels provide further insight into the systemic inflammatory response associated with MOD post-CPB.