In order to study the occurrence of postbypass
hyperamylasemia, 75 patients undergoing
cardiopulmonary bypass (CPB) were studied from March 1989 to January 1990. There were 49 males and 26 females. Among them, 27 had
congenital heart disease, 30 had valvular disease, and 18 had
coronary artery disease. There were 27 patients with at least one elevated serum
amylase sample after operation. Thus, the overall incidence of
hyperamylasemia was 36%. As compared with the preoperative data (1.3%), there was a statistically significant difference in the occurrence of
hyperamylasemia (p less than 0.05). Three patients had overt clinical
pancreatitis postoperatively. There was no positive correlation between the serum
amylase level and the occurrence of
pancreatitis (p greater than 0.05). Forty-two cases had a significant elevation of the
amylase creatinine clearance ratio (ACCR) after CPB. However, there was no significant difference between the groups with pulsatile and nonpulsatile CPB (p greater than 0.05). Three patients (4%) died in our series. The causes of death were
heart failure in two and fulminant
pancreatitis associated with
low cardiac output in one. Although our experience in dealing with
pancreatitis improved survival, mortality was still high (33.3%) in our series. Nevertheless, there was no apparent correlation between mortality and postbypass
hyperamylasemia (p greater than 0.05). Logistic regression analysis was used to analyze the risk factors of the occurrence of
hyperamylasemia, and the analysis revealed that patients with
coronary artery disease were susceptible to postbypass
hyperamylasemia. Our studies indicate that the use of total serum
amylase or ACCR to monitor for the occurrence of
pancreatitis in postbypass patients is inadequate.(ABSTRACT TRUNCATED AT 250 WORDS)