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Anaesthesia. 2019 May;74(5):609-618. doi: 10.1111/anae.14577. Epub 2019 Jan 27.

Postoperative microcirculatory perfusion and endothelial glycocalyx shedding following cardiac surgery with cardiopulmonary bypass.

Author information

1
Departments of Anaesthesiology, Physiology, and Cardiothoracic Surgery, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
2
Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam UMC, VU University, Amsterdam Infection and Immunity Institute, Amsterdam, the Netherlands.
3
Department of Cardiothoracic Surgery, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
4
Department of Anaesthesiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.

Abstract

We investigated microcirculatory perfusion disturbances following cardiopulmonary bypass in the early postoperative period and whether the course of these disturbances mirrored restoration of endothelial glycocalyx integrity. We performed sublingual sidestream dark field imaging of the microcirculation during the first three postoperative days in patients who had undergone on-pump coronary artery bypass graft surgery. We calculated the perfused vessel density, proportion of perfused vessels and perfused boundary region. Plasma was obtained to measure heparan sulphate and syndecan-1 levels as glycocalyx shedding markers. We recruited 17 patients; the mean (SD) duration of non-pulsatile cardiopulmonary bypass was 103 (18) min, following which 491 (29) ml autologous blood was transfused through cell salvage. Cardiopulmonary bypass immediately decreased both microcirculatory perfused vessel density; 11 (3) vs. 16 (4) mm.mm-2 , p = 0.052 and the proportion of perfused vessels; 92 (5) vs. 69 (9) %, p < 0.0001. The proportion of perfused vessels did not increase after transfusion of autologous salvaged blood following cardiopulmonary bypass; 72 (7) %, p = 0.19 or during the first three postoperative days; 71 (5) %, p < 0.0001. The perfused boundary region increased after cardiopulmonary bypass; 2.2 (0.3) vs. 1.9 (0.3) μm, p = 0.037 and during the first three postoperative days; 2.4 (0.3) vs. 1.9 (0.3) μm, p = 0.003. Increased plasma heparan sulphate levels were inversely associated with the proportion of perfused vessels during cardiopulmonary bypass; R = -0.49, p = 0.02. Plasma syndecan-1 levels were inversely associated with the proportion of perfused vessels during the entire study period; R = -0.51, p < 0.0001. Our study shows that cardiopulmonary bypass-induced acute microcirculatory perfusion disturbances persist in the first three postoperative days, and are associated with prolonged endothelial glycocalyx shedding. This suggests prolonged impairment and delayed recovery of both microcirculatory perfusion and function after on-pump cardiac surgery.

KEYWORDS:

blood oxygen transport, oxygen delivery to tissues: factors impacting; cardiopulmonary bypass management; endothelial glycocalyx; microcirculation

PMID:
30687934
PMCID:
PMC6590376
DOI:
10.1111/anae.14577
[Indexed for MEDLINE]
Free PMC Article

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