The effect of femoral vein cannulation on de ritis ratio in cardiopulmonary bypass

The AST/ALT ratio, also known as the De Ritis ratio, is used as a rapid and reliable marker for hepatocyte damage, cardiac and cardiovasculary disease and some types of cancer. In this study, we aimed to investigate the effects of femoral vein cannulation, which is the most preferred cannulation type after central vein cannulation during CPB, on De Ritis ratio. We included our study 450 patients who underwent CPB between 2019 and 2021. Preoperative and postoperative serum AST, ALT, GGT and CRP levels were collected retrospectively of the patients who were divided into two groups as central (n=218) and femoral (n=232) according to the cannulation side. The data obtained were statistically evaluated in the SPSS 21.0 program. De Ritis ratio in the central cannulation group was respectively calculated as 1.13 and 1.68 (p<0.05) in the preoperative and postoperative periods. Serum GGT (32, 36.5, respectively) and CRP (3.85, 17.1, respectively) levels showed a statistically significant increase in the postoperative period compared to the preoperative period (p<0.05). In the femoral cannulation group, in the postoperative period compared to the preoperative period while serum AST (17, 22, respectively), ALT (18, 26, respectively), GGT (21, 24, respectively) and CRP (1.9, 6.85, respectively) levels increased significantly (p< 0.05), no statistically significant change was observed in the De Ritis ratio (p>0.05). In the light of the data we have obtained, we think that central vein cannulation is mostly associated with myocardial damage processes, and that the severely increased ALT level in femoral vein cannulation is caused by insufficient organ perfusion and hepatocyte damage.