A large body of research states that with a drop in hematocrit levels to below 17%, the patient will have serious complications; and if the hematocrit level drops below 14%, the patient might be at risk of death.9-13 In our study, the lowest hematocrit level was not below 22%; consequently, we found no significant relationship

between the hematocrit level before surgery, lowest hematocrit level on pump, and changes in the liver function tests. Mc Sweeny et al.14 stated that a history of myocardial infarction, revascularization, and ejection fraction below 40% were the independent factors affecting postoperative gastrointestinal complications. Moreover, the authors #check details keyword# found that a history of renal failure was effective in the occurrence of gastrointestinal complications. Also, Raman et al.15 reported that a history of diabetes mellitus and heart failure Inhibitors,research,lifescience,medical could cause severe liver ischemia after cardiac surgeries. In our study, a history of diabetes had a significant relationship with direct bilirubin changes, and not with the other liver function tests. Also, myocardial infarction and preoperative creatinine levels did not have a significant relationship with any of the liver function tests, while the ejection fraction had a reverse significant relationship with the changes in the ALP levels and the CVP pressure had a direct and significant relationship with the changes in the liver enzymes. The Inhibitors,research,lifescience,medical results of the present study

Inhibitors,research,lifescience,medical are not in agreement with that of in some previous studies. Conflicting results can also be found between the previous investigations; this is because different studies employ different markers for detecting hepatocellular injury such as alcohol dehydrogenase (AD) and glutathione S-transferase (GST). It is worthy of note that we used conventional transaminases, which are, albeit a lesser Inhibitors,research,lifescience,medical indicator of hepatic damage, more practical than the others. Holmes showed that using inotrope and vasopressors could increase visceral vascular resistance

and cause ischemia by vascular contracture. For instance, while infusion of epinephrine could increase cardiac output, it would reduce visceral perfusion.16 In our study, inotrope and vasopressors were infused for all the patients until the first postoperative day. Therefore, we could not assess their effect on the changes in the liver function tests. Some researchers have reported that the use of intra-aortic balloon pumps could reduce tissue perfusion and cause gastrointestinal complications, especially liver Idoxuridine complications.8 In our study, only AST had a considerably significant increase in the patients for whom intra-aortic balloon pumps were used. Another study showed that inadequate venous drainage caused liver congestion and increased postoperative liver damage. Venous drainage during CPB depends on multiple factors.17 However, during CPB, the amount of the pump flow directly correlates with the amount of systemic venous return. In our study, the pump flow was maintained at 2.4-2.