Hepatopancreaticobiliary Values after Thoracoabdominal Aneurysm Repair

Abstract

Background: After thoracoabdominal aortic aneurysm (TAAA) repair, blood tests assessing hepatopancreaticobiliary (HPB) organs commonly have abnormal results. The clinical significance of such abnormalities is difficult to determine because the expected postoperative levels have not been characterized. Therefore, we sought to establish expected trends in HPB laboratory values after TAAA repair.

Methods: This 5-year study comprised 155 patients undergoing elective Crawford extent II TAAA repair. In accordance with a prospective study protocol, all repairs involved left-sided heart bypass, selective visceral perfusion, and cold renal perfusion. Blood levels of aspartate transaminase (AST), alanine transaminase (ALT), γ-glutamyl transpeptidase (GGT), lactate dehydrogenase (LDH), total bilirubin, amylase, and lipase were measured before TAAA repair and for 7 days afterward. Ratios between postoperative and baseline levels were compared for each time point with 95% confidence intervals.

Results: Temporal patterns for the laboratory values varied greatly. Amylase, lipase, and AST underwent significant early increases before decreasing to preoperative levels. LDH increased immediately and remained significantly elevated, whereas ALT increased more gradually. GGT remained near baseline through postoperative day 4, and then increased to more than twice baseline. Total bilirubin never differed significantly from baseline. After adjusted analysis, the ischemic time predicted the maximum AST, lipase, GGT, and LDH values.

Conclusions: Although most HPB laboratory values increase significantly after elective TAAA repair, the temporal trends for different values vary substantially. The ischemic time predicts the maximum AST, lipase, GGT, and LDH levels. These trends should be considered when laboratory values are assessed after TAAA repair.

Key Words

Thoracoabdominal aortic aneurysm - Hepatopancreaticobiliary function - Laboratory values - Alanine transaminase - Aspartate transaminase

• References

• 1 LeMaire SA, Jones MM, Conklin LD, Carter SA, Criddell MD, Wang XL. , et al. Randomized comparison of cold blood and cold crystalloid renal perfusion for renal protection during thoracoabdominal aortic aneurysm repair. J Vasc Surg 2009; 49: 11-19 . 10.1016/j.jvs.2008.08.048
• 2 Kratz A, Pesce MA, Basner RC, Einstein AJ. Laboratory values of clinical importance. In: Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J. Harrison's Principles of Internal Medicine. , 18th Edition. New York: McGraw-Hill; 2012. , p. 3585-3610
• 3 Okano N, Miyoshi S, Owada R, Fujita N, Kadoi Y, Saito S. , et al. Impairment of hepatosplanchnic oxygenation and increase of serum hyaluronate during normothermic and mild hypothermic cardiopulmonary bypass. Anesth Analg 2002; 95: 278-286 . 10.1213/00000539-200208000-00004
• 4 Chetty G, Sharpe DA, Nandi J, Butler SJ, Mitchell IM. Liver blood flow during cardiac surgery. Perfusion 2004; 19: 153-156 . 10.1191/0267659104pf735oa
• 5 Sander M, Spies CD, Berger K, Schröder T, Grubitzsch H, Wernecke KD. , et al. Perioperative indocyanine green clearance is predictive for prolonged intensive care unit stay after coronary artery bypass grafting–an observational study. Crit Care 2009; 13: R149 . 10.1186/cc8045
• 6 Kunihara T, Shiiya N, Wakasa S, Matsuzaki K, Matsui Y. Assessment of hepatosplanchnic pathophysiology during thoracoabdominal aortic aneurysm repair using visceral perfusion and shunt. Eur J Cardiothorac Surg 2009; 35: 677-683 . 10.1016/j.ejcts.2008.12.016
• 7 Browning JD, Horton JD. Molecular mediators of hepatic steatosis and liver injury. J Clin Invest 2004; 114: 147-152 . 10.1172/JCI200422422
• 8 Jensen PD, Jensen FT, Christensen T, Nielsen JL, Ellegaard J. Relationship between hepatocellular injury and transfusional iron overload prior to and during iron chelation with desferrioxamine: a study in adult patients with acquired anemias. Blood 2003; 101: 91-96 . 10.1182/blood-2002-06-1704
• 9 Harward TR, Welborn 3rd MB, Martin TD, Flynn TC, Huber TS, Moldawer LL. , et al. Visceral ischemia and organ dysfunction after thoracoabdominal aortic aneurysm repair. A clinical and cost analysis. Ann Surg 1996; 223: 729-734 , discussion 734-736.
• 10 Welborn MB, Oldenburg HSA, Hess PJ, Huber TS, Martin TD, Rauwerda JA. , et al. The relationship between visceral ischemia, proinflammatory cytokines, and organ injury in patients undergoing thoracoabdominal aortic aneurysm repair. Crit Care Med 2000; 28: 3191-3197 . 10.1097/00003246-200009000-00013
• 11 Safi HJ, Miller 3rd CC, Yawn DH, Iliopoulos DC, Subramaniam M, Harlin S. , et al. Impact of distal aortic and visceral perfusion on liver function during thoracoabdominal and descending thoracic aortic repair. J Vasc Surg 1998; 27: 145-152 , discussion 152-153. 10.1016/S0741-5214(98)70301-5