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Side‐by‐Side Alterations in Glycocalyx Thickness and Perfused Microvascular Density During Acute Microcirculatory Alterations in Cardiac Surgery
Author(s) -
Koning Nick J.,
Vonk Alexander B. A.,
Vink Hans,
Boer Christa
Publication year - 2016
Publication title -
microcirculation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.793
H-Index - 83
eISSN - 1549-8719
pISSN - 1073-9688
DOI - 10.1111/micc.12260
Subject(s) - perfusion , glycocalyx , cardiopulmonary bypass , medicine , pulsatile flow , cardiology , microcirculation , immunology
Objectives Endothelial glycocalyx injury causes microcirculatory perfusion disturbances in experimental studies, but the relevance in a clinical setting remains unknown. We investigated whether glycocalyx dimensions are reduced after onset of CPB and whether this is associated with alterations in microvascular perfusion. Methods The current observational study included 36 patients undergoing cardiac surgery without or with CPB, using either nonpulsatile or pulsatile flow. Sublingual microcirculatory perfusion was assessed perioperatively and analyzed for perfused vessel density and PBR, an inverse parameter of endothelial glycocalyx dimensions. Results Perfused vessel density decreased after onset of CPB in parallel with an increase in PBR in both pulsatile and nonpulsatile groups. In the nonpulsatile CPB group, these alterations were still persistent in the ICU ( PVD : T1 19.8 ± 2.8 mm/mm 2 vs. T3 15.3 ± 2.6 mm/mm 2 ; p = 0.004. PBR : T1 2.40 ± 0.35 μ m vs. T3 2.60 ± 0.31 μ m; p = 0.020). In the off‐pump group, perfused vessel density remained unaltered. An inverse correlation between perfused vessel density and PBR was detected. Conclusions This study shows that endothelial glycocalyx dimensions decrease after onset of CPB and are closely related to microvascular perfusion when assessed with a novel, noninvasive technique.