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J Thorac Cardiovasc Surg 2008;136:129-134
© 2008 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Impaired sublingual microvascular perfusion during surgery with cardiopulmonary bypass: A pilot study

Corstiaan A. den Uil, MDa,*, Wim K. Lagrand, MD, PhDa, Peter E. Spronk, MD, PhDb,c, Ron T. van Domburg, PhDa, Jan Hofland, MD, PhDa, Christian Lüthen, MDa, Jasper J. Brugts, MD, MSca, Martin van der Ent, MD, PhDa, Maarten L. Simoons, MD, PhDa

a Erasmus MC Thoraxcenter, Rotterdam, The Netherlands
b Gelre Hospitals, Lukas site, Apeldoorn, The Netherlands
c HERMES critical care group, Amsterdam, The Netherlands

Received for publication August 17, 2007; revisions received September 27, 2007; accepted for publication October 19, 2007.

* Address for reprints: C. A. den Uil, MD, Erasmus Medical Center, Department of Cardiology, Room Hs-302, PO Box 2040, NL-3000 CA Rotterdam, The Netherlands. (Email: c.denuil{at}erasmusmc.nl).

Objective: Complications after cardiac surgery may involve multiple organ failure, which carries a high mortality. Development of multiple organ failure may be related to impaired microcirculatory perfusion as a result of systemic inflammation. Microcirculatory blood flow alterations have been associated with impaired outcome. We investigated whether these alterations occurred before, during, and after coronary artery bypass grafting.

Methods: We observed 25 consecutive patients who underwent elective coronary artery bypass grafting with cardiopulmonary bypass. The sublingual microcirculation was investigated using side-stream dark-field imaging. Side-stream dark-field imaging was performed before (baseline), during, and after surgery. Microvascular blood flow was estimated with a semiquantitative microvascular flow index in small, medium, and large microvessels. Changes in microvascular flow were tested with Wilcoxon signed rank test.

Results: Median microvascular flow index of medium blood vessels decreased after starting cardiopulmonary bypass relative to that after anesthetic induction (2.6, interquartile range 1.6–3.0, vs 3.0, interquartile range 2.8–3.0, P = .02). There was a trend toward decreased microvascular flow index of small and large vessels relative to baseline (P = .08 and P = .05, respectively). Decreases in microvascular flow index occurred irrespective of changes in systemic blood pressure. After each patient's return to the intensive care unit, microvascular flow index increased and normalized in all microvessels.

Conclusion: For the first time, sublingual microvascular blood flow alterations have been observed during cardiopulmonary bypass–assisted coronary artery bypass grafting.

Abbreviations and Acronyms CABG = coronary artery bypass grafting; CPB = cardiopulmonary bypass; IQR = interquartile range; MAP = mean arterial pressure; MFI = microvascular flow index; SDF = side-stream dark-field




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