Perioperative changes in the microvascular perfused boundry 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 Centre, 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.

We assume that the increase of perfused boundry region will be more pronounced with the use of a phosphorylcholine-coated extracorporal circuit then with the use of a heparin-coated extracorporeal circuit.

Blood will be drawn and several microcirculatory imaging parameters will be measured before surgery (T0), before (T1) and after administration of heparin (T2), after initiation of CPB (T3), after placement of the side clamp (T4), after administration of protamine (T5), after infusion of concentrated red blood cells (T6), 3 hours after the patient has arrived at the ICU (T7), and 24 hours (T8) and 72 hours (T9) following surgery

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