Correlation between acute degradation of the endothelial glycocalyx and microcirculation dysfunction during cardiopulmonary bypass in cardiac surgery

Qing, WU; Gao, Wei; Zhou, Jiahao; He, Guoliang; Ye, Junxin; Fang, Fuquan; Liu, Junwei; Wang, Mengcong; Han, Xu; Wang, Weijian

doi:10.1016/j.mvr.2019.02.004

Cited by 30 publications

(38 citation statements)

References 37 publications

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“…27À31 Because the endothelial glycocalyx acts as first line defense of the vascular endothelium, shedding of its constituents is postulated as early marker for endothelial injury and altered vascular functioning. 5,27,30,32 Remarkably, the authors found that CPB-induced microcirculatory perfusion disturbances were not affected by the type of coating, despite a more pronounced preservation of the glycocalyx layer in the heparin coating group. These results suggest that microcirculatory perfusion disturbances in cardiac surgery patients can be present irrespective of intact endothelial glycocalyx.…”

Section: Discussionmentioning

confidence: 94%

Microvascular Alterations During Cardiac Surgery Using a Heparin or Phosphorylcholine-Coated Circuit

Dekker

Veerhoek

Leeuwen

et al. 2020

Journal of Cardiothoracic and Vascular Anesthesia

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Objective: Heparin biocompatible coating frequently is used to reduce inflammation and blood coagulation during cardiopulmonary bypass (CPB) in cardiac surgery. Whether heparin coating is protective or damaging to the vascular endothelium is unclear. The authors investigated whether heparin-coated (HC) circuits are associated with better preservation of microcirculatory perfusion and glycocalyx dimensions compared with nonheparin phosphorylcholine-coated (PC) circuits. Design: Prospective, randomized blinded study. Setting: Tertiary university hospital. Participants: A total of 26 adults undergoing elective coronary artery bypass graft surgery with CPB. Interventions: PC (n = 13) versus HC circuits (n = 13). Measurements and Main Results: Sublingual microcirculatory perfusion was measured before, during, and after CPB using sidestream dark field imaging and analyzed for perfused vessel density and perfused boundary region, an inverse parameter for glycocalyx dimensions. Onset of CPB was associated with an increase in perfused boundary region in the PC group that continued until the third postoperative day (2.0 § 0.2 to 2.5 § 0.2 mm; p = 0.018). This was paralleled by increased plasma syndecan-1 levels in the PC group. Contrastingly, both parameters remained unaltered in the HC group compared with baseline levels. CPB decreased perfused vessel density in both groups (CPB v pre-CPB: PC: 17 § 2 to 13 § 2 mm/mm 2 , p = 0.006; HC: 16 § 2 to 11 § 2 mm/mm 2 , p = 0.003) and remained equally altered in the first 3 postoperative days. Conclusion: The use of an HC circuit is associated with better preservation of the endothelial glycocalyx compared with PC circuits, whereas microcirculatory perfusion was disturbed equally in both groups. Hence, CPB-induced microcirculatory perfusion disturbances seem to be coating independent.

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Section: Discussionmentioning

confidence: 94%

Microvascular Alterations During Cardiac Surgery Using a Heparin or Phosphorylcholine-Coated Circuit

Dekker

Veerhoek

Leeuwen

et al. 2020

Journal of Cardiothoracic and Vascular Anesthesia

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“…Another study with 15 patients showed a temporary decrease of PVD and the De Backer score during ONCAB and elective valve surgery. 36 The transient decrease of microcirculatory perfusion was associated with a simultaneous increase in glycocalyx shedding markers during anesthesia and CPB.…”

Section: Endothelial Function and The Glycocalyx During Cardiac Surgerymentioning

confidence: 99%

Monitoring of the Sublingual Microcirculation During Cardiac Surgery: Current Knowledge and Future Directions

Flick

Duranteau

Scheeren

et al. 2020

Journal of Cardiothoracic and Vascular Anesthesia

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“…These results were confirmed in a study performed with human volunteers by Nieuwdorp et al [ 25 ] Reductions in glycocalyx thickness following endotoxin infusion were observed in this latter study in the capillaries of 5–7 μm diameter concomitantly with microcirculatory alterations. Relationships between reduced EG thickness and alterations in the microvasculature were also demonstrated in cardiopulmonary bypass patients [ 26 , 27 , 28 ] and individuals exhibiting chronic oxidative stress [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Links between Endothelial Glycocalyx Changes and Microcirculatory Parameters in Septic Patients

Belousoviene

Kiudulaitė

Pilvinis

et al. 2021

Life

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The glycocalyx is an endothelial surface layer that is essential for maintaining microvascular homeostasis. Impaired integrity of the endothelial glycocalyx may be directly related to the development of microvascular dysfunction. To explore this hypothesis, we conducted a prospective observational study on adult patients diagnosed with sepsis. The study aimed to evaluate the degree of damage to the glycocalyx and to identify correlations between microcirculatory parameters and glycocalyx thickness based on capillary diameter. Sublingual microcirculation was examined using a handheld Cytocam-incident dark field video microscope. A sidestream dark field video microscope attached to a GlycoCheck monitor was used to determine the perfused boundary regions (PBRs) of sublingual blood vessels grouped by diameter (5–9 μm, 10–19 μm, and 20–25 μm). We identified significant damage to the glycocalyx in sublingual blood vessels of all the aforementioned diameters in septic patients compared to healthy age-matched controls. Furthermore, we found that the PBRs of the smallest capillaries (diameter class 5–9µm) correlated moderately and inversely with both total and perfused blood vessel densities. Collectively, our data suggest that there may be a functional relationship between damage to the endothelial glycocalyx of the smallest capillaries and alterations in the microcirculation observed in response to sepsis.

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Correlation between acute degradation of the endothelial glycocalyx and microcirculation dysfunction during cardiopulmonary bypass in cardiac surgery

Cited by 30 publications

References 37 publications

Microvascular Alterations During Cardiac Surgery Using a Heparin or Phosphorylcholine-Coated Circuit

Microvascular Alterations During Cardiac Surgery Using a Heparin or Phosphorylcholine-Coated Circuit

Monitoring of the Sublingual Microcirculation During Cardiac Surgery: Current Knowledge and Future Directions

Links between Endothelial Glycocalyx Changes and Microcirculatory Parameters in Septic Patients

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