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J Thorac Cardiovasc Surg 2009;138:1445-1447
© 2009 The American Association for Thoracic Surgery

Brief Research Report

Shedding of the endothelial glycocalyx during cardiac surgery: On-pump versus off-pump coronary artery bypass graft surgery

^a Clinic of Anesthesiology, Ludwig-Maximilians-University, Munich, Germany
^b Department of Anatomy, Ludwig-Maximilians-University, Munich, Germany
^c Department of Medical Informatics, Biometry, and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
^d Department of Cardiac Surgery, Ludwig-Maximilians-University, Munich, Germany
^e Institute of Physiology, Ludwig-Maximilians-University, Munich, Germany

Received for publication July 8, 2008; revisions received July 22, 2008; ^_* Address for reprints: Dirk Bruegger, MD, Clinic of Anesthesiology, Ludwig-Maximilians-University, Marchioninistr. 15, D-81377 Munich, Germany. (Email: dirk.bruegger@med.uni-muenchen.de).

The first 20% of the full text of this article appears below.

	Introduction

 
A healthy vascular endothelium is coated by the endothelial glycocalyx. Its main constituents are transmembrane syndecans and bound heparan sulfates. In vivo the glycocalyx binds plasma proteins, forming the endothelial surface layer, which has a thickness of 500 to 1000 nm in microvessels.¹ This large structure maintains the physiologic permeability barrier and prevents leukocyte and platelet adhesion, thereby mitigating inflammation and tissue edema.^1,2

Very recently, we provided the first evidence for an acute destruction of the endothelial glycocalyx in patients undergoing aortic surgery associated with ischemia–reperfusion injury.³ Avoiding cardiopulmonary bypass (CPB) and cardioplegic arrest, including ischemia and reperfusion, should presumably reduce shedding of the endothelial glycocalyx. In the present study shedding of components of the endothelial glycocalyx (heparan sulfate and syndecan-1) was investigated in patients undergoing coronary artery bypass surgery with and without CPB.

	Clinical Summary

 
Patients referred for elective coronary artery bypass surgery were prospectively randomized to on-pump conventional coronary artery bypass (CCAB; n = 15) or off-pump coronary artery bypass (OPCAB; n = 15) surgery. Exclusion criteria were former or combined cardiac procedures and renal or hepatic dysfunction. Before surgical intervention, written informed consent was obtained from each patient. The study was approved by the ethics committee of our institution. CCAB and OPCAB . . . [Full Text of this Article]