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Postoperative hyperamylasaemia in cardiac surgery

H Paajanen1, A Harmoinen, T Sisto

  • 1Department of Surgery, Kuopio University Hospital, Finland.

Scandinavian Cardiovascular Journal : SCJ
|January 1, 1997
PubMed
Summary

Postoperative hyperamylasaemia after coronary artery bypass grafting (CABG) is common, primarily due to decreased renal excretion of pancreatic amylase, not pancreatic damage. This finding helps clarify amylase level changes post-cardiac surgery.

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Area of Science:

  • Cardiovascular Surgery
  • Clinical Biochemistry
  • Nephrology

Background:

  • Postoperative hyperamylasaemia is frequently observed following coronary artery bypass grafting (CABG).
  • The precise mechanism, distinguishing between pancreatic damage and altered clearance, remains unclear.

Purpose of the Study:

  • To investigate the underlying mechanisms of postoperative hyperamylasaemia in patients undergoing CABG.
  • To differentiate the contributions of salivary (S-) and pancreatic (P-) isoamylases to elevated serum amylase levels post-CABG.
  • To assess the role of renal function in the clearance of amylase isoenzymes after CABG.

Main Methods:

  • Study included 48 patients undergoing CABG.
  • Serial measurements of serum total amylase, salivary isoamylase (S-amylase), and pancreatic isoamylase (P-amylase) were performed.

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  • Renal function was assessed by measuring serum creatinine, creatinine clearance, and urinary albumin concentration.
  • Fractional clearance of S- and P-amylase relative to creatinine clearance was calculated.

    • Main Results:

    • Hyperamylasaemia occurred in 87% of patients, with 10% showing levels > 1000 U/l.
    • Elevated amylase levels peaked 24 hours post-CABG, predominantly composed of the P-amylase component.
    • Renal function markers remained normal, ruling out significant renal impairment.
    • Fractional clearance of P-amylase decreased significantly more than S-amylase post-CABG (3.6% to 0.9% vs. 1.3% to 0.8%).

    Conclusions:

    • The primary cause of postoperative hyperamylasaemia after CABG is a reduced urinary excretion rate of pancreatic isoamylase.
    • Pancreatic cellular damage is unlikely to be the main contributor to elevated serum amylase levels in this context.
    • Altered renal handling of amylase isoenzymes is the key factor in post-CABG hyperamylasaemia.