Perturbation of the microvascular glycocalyx and perfusion in infants after cardiopulmonary bypass
Open accessAbstract
Objective Perturbation of the endothelial glycocalyx is discussed in the pathogenesis of complications related to cardiopulmonary bypass. We evaluated the effects of cardiopulmonary bypass on the microcirculation and the microvascular endothelial glycocalyx of infants undergoing surgery for congenital cardiac defects.Methods The microcirculation was visualized at the ear conch using Sidestream dark field imaging before surgery (T0), after admission to the intensive care unit (T1), 24 hours postsurgery (T2), and 7 days postsurgery (T3). Glycocalyx thickness was assessed by measurement of the perfused boundary region. Microcirculatory parameters included total and perfused vessel density, vessel diameters, and microcirculatory flow index.Results A total of 40 infants undergoing cardiac surgery (36 with cardiopulmonary bypass, 4 without cardiopulmonary bypass) were examined. As controls, measurements before and after cardiac catheterization (n = 6) and before and after surgery for cleft palate (n = 9) were performed. After surgery with cardiopulmonary bypass, the perfused boundary region was significantly increased, indicating reduced glycocalyx thickness at T1 compared with preoperative values with a stepwise return to baseline by T3. In the control groups, no significant perfused boundary region changes were noted. Furthermore, after cardiopulmonary bypass, a transient, significant reduction of the microcirculatory flow index and the perfused vessel density was seen at T1. Similar changes were observed after cardiac surgery without cardiopulmonary bypass, but not in the other controls.Conclusions Our study reveals for the first time local perturbations of the endothelial glycocalyx and microvascular perfusion in infants after surgery with cardiopulmonary bypass. Microcirculatory monitoring might be a useful tool to evaluate interventions aiming at reduction of bypass-related complications.
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Cardiopulmonary bypass causes transient disturbances in glycocalyx thickness, microvascular flow index, and perfused vessel density that normalize within a week postoperatively.
“Nussbaum et al. employed SDF imaging to study the effects of cardiopulmonary bypass on skin microcirculation, reporting transient disturbances in glycocalyx thickness, microvascular flow index (MFI), and perfused vessel density (PVD), which normalized within a week postoperatively [85].”
From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [85]
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- Authors
- Nussbaum, C., Haberer, A., Tiefenthaller, A., Januszewska, K., Chappell, D., Brettner, F., Mayer, P., Dalla Pozza, R., & Genzel-Boroviczény, O.
- Affiliations
- Ludwig-Maximilians-Universität München (DE)
- University of Münster (DE)
- Corresponding author
- Nussbaum, Claudia
- Venue
- The Journal of Thoracic and Cardiovascular Surgery
- Publisher
- Elsevier BV
- Published
- 2015-12
- Volume
- 150
- Issue
- 6
- Pages
- 1474-1481.e1
- ISSN
- 0022-5223 (ISSN-L)
- OpenAlex
- W1144057699
- Cited by
- 41
- References
- 39
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 5 · 2023: 5 · 2022: 4 · 2021: 7 · 2020: 1 · 2019: 8 · 2018: 2 · 2017: 1 · 2016: 2 · 2015: 1
- FWCI
- 2.01
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Deutsche Gesellschaft für Pädiatrische Kardiologie
- Topics
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Keywords
- cardiopulmonary bypass, endothelial glycocalyx, microvascular blood flow, microcirculation, infants, congenital heart disease, perfused boundary region, perfused vessel density, sidestream dark field imaging, microcirculatory monitoring, cardiac surgery complications
- MeSH terms
- Adolescent, Cardiopulmonary Bypass, Child, Child, Preschool, Cleft Palate, Ear, External, Female, Heart Defects, Congenital, Cardiac Surgical Procedures, Humans, Male, Microcirculation, Case-Control Studies, Treatment Outcome, Glycocalyx
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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