Trypsinogen is not activated during cardiac surgery with extracorporeal circulation

Abstract

Amylase, immunoreactive cationic trypsin (ogen) and complexes of cationic trypsin and α₁-proteinase inhibitor were analysed in plasma samples from 41 patients following cardiac surgery with extracorporeal circulation. Postoperative hyperamylasaemia was seen in seven patients (17%). In 10 patients there were elevated levels (>100 µg 1⁻¹) of immunoreactive cationic trypsin(ogen) on the first postoperative day. After gelfiltration, samples from these 10 patients were analysed for trypsin-α₁-proteinase inhibitor complexes, with a solid-phase, double-antibody enzyme-linked immunoassay. The median preoperative level of trypsin-α₁-proteinase inhibitor complexes was 4.5 µg 1⁻¹ (range 3.3–11.9) and the median value on the first postoperative day was 5.5 µg 1⁻¹ (range 2.6-14). The ratio between complexes and immunoreactive trypsin (ogen) decreased (p<0.05) showing that activation of trypsinogen did not occur. This fact argues against the development of protease-mediated subclinical pancreatitis during cardiac surgery with extracorporeal circulation.

Key Words:

• amylase
• cationic trypsinogen
• hyperamylasaemia
• pancreatitis
• trypsin-α₁-proteinase inhibitor complexes