Perioperative changes in the microvascular perfused boundary region in patients undergoing coronary artery bypass grafting

The endothelial glycocalyx (EGC) is a gel-like layer that acts as a natural
coating for endothelial cells, thereby preventing these cells from having
direct contact with circulating blood cells. In order to reduce the
inflammatory and procoagulant response during cardiopulmonary bypass in
patients undergoing cardiac surgery through contact activation, extracorporeal
circuits are coated with a biocompatible surface. In VU University Medical
Center, cardiopulmonary bypass is mostly performed using a heparin-coated
extracorporeal circuit in combination with full anticoagulation by heparin
infusion. Alternatively, a phosphorylcholine-coated extracorporeal circuit is
used, but it is unknown how these different biocompatible-coated extracorporeal
circuits will contribute to the preservation of the glycocalyx during cardiac
surgery.

To identify the influence of two different biocompatible-coated extracorporeal
circuits on the perfused boundary region of the sublingual microvasculature as
measured by the GlycoCheck Sidestream Darkfield Imaging camera.

Single-center prospective, randomized study in the VU University Medical
Center.

Both extracorporeal circuits are part of daily clinical care during
cardiothoracic surgery and will not add up to patient risk and burden.
Intravital microscopic imaging of the sublingual microvasculature by means of
the GlycoCheck is a noninvasive measurement and will take before, during and up
to 72 hours following surgery. A total of 80 ml of extra blood will be drawn
from an existing intra-arterial line while the patient is under anesthesia. The
intra-arterial line is part of routine clinical care in cardiac surgery, and
will therefore not add up to patient discomfort in the present study.