Elevated Liver Enzyme after Cardiac Surgery by on Pump Method

Abstract

Elevated liver enzymes after on-pump cardiac surgery indicate potential recovery delays, complications, and long-term damage. The heart-lung machine can cause liver injury, leading to longer hospital stays and risks from systemic inflammatory response syndrome (SIRS). Factors like mechanical stress and ischemia-reperfusion injury release inflammatory mediators that harm liver cells. Key markers of liver injury include alanine aminotransferase (ALT) and aspartate aminotransferase (AST), with ALT being more specific. Increased alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) may suggest biliary problems. Ischemia-reperfusion injury occurs when blood flow is interrupted, causing oxidative stress that affects liver health. Cannulating the vena cavae can worsen liver congestion and damage, especially if improperly placed, risking ischemic injury and liver function impairment. Surgeons should consider pre-existing liver conditions, as they can worsen cannulation effects. Cardiopulmonary bypass (CPB) can disrupt liver microcirculation, affecting oxygen and nutrient delivery. Mechanical hemolysis from the machine can release toxic substances that harm the liver. Anesthetics and antibiotics may also elevate liver enzymes. Risk factors include prolonged CPB times, existing liver issues, older age, obesity, diabetes, kidney dysfunction, and chronic alcohol use. To manage liver enzymes, optimizing CPB techniques and monitoring liver function post-surgery are crucial. Understanding the inflammatory response linked to on-pump techniques can enhance patient care and outcomes.

Keywords

• liver enzyme
• cardiac surgery
• cardiopulmonary bypass
• cytokines
• ischemia-reperfusion injury