title: Systemic microvascular shunting through hyperdynamic capillaries after acute physiological disturbances following cardiopulmonary bypass.
abstract: Previously we showed that cardiopulmonary bypass (CPB) during cardiac surgery is associated with reduced sublingual microcirculatory perfusion and oxygenation. It has been suggested that impaired microcirculatory perfusion may be paralleled by increased heterogeneity of flow in the microvascular bed, possibly leading to arteriovenous shunting. Here we investigated our hypothesis that acute hemodynamic disturbances during extracorporeal circulation indeed lead to microcirculatory heterogeneity with hyperdynamic capillary perfusion and reduced systemic oxygen extraction. In this single-center prospective observational study, patients undergoing cardiac surgery with (n = 18) or without (n = 13) CPB were included. Perioperative microcirculatory perfusion was assessed sublingually with sidestream darkfield imaging, and recordings were quantified for microcirculatory heterogeneity and hyperdynamic capillary perfusion. The relationship with hemodynamic and oxygenation parameters was analyzed. Microcirculatory heterogeneity index increased substantially after onset of CPB [0.5 (0.0-0.9) to 1.0 (0.3-1.3); P = 0.031] but not during off-pump surgery. Median capillary red blood cell (RBC) velocity increased intraoperatively in the CPB group only [1,600 (913-2,500 μm/s) vs. 380 (190-480 μm/s); P < 0.001], with 31% of capillaries supporting high RBC velocities (>2,000 μm/s). Hyperdynamic microcirculatory perfusion was associated with reduced arteriovenous oxygen difference and systemic oxygen consumption during and after CPB. The current study provides the first direct human evidence for a microvascular shunting phenomenon through hyperdynamic capillaries following acute physiological disturbances after onset of CPB. The hypothesis of impaired systemic oxygen offloading caused by hyperdynamic capillaries was supported by reduced blood arteriovenous oxygen difference and low systemic oxygen extraction associated with CPB.
authors: Department of Anesthesiology. Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands; Departments of Integrated Neurovascular Biology, Institut National de la Santé et de la Recherche Médicale U1083, Centre National de la Recherche Scientifique UMR 6214; n.koning@vumc.nl.
authors: Nick J
authors: NJ
authors: Koning
authors: Department of Anesthesiology. Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands;
authors: Lotte E
authors: LE
authors: Simon
authors: Departments of Integrated Neurovascular Biology, Institut National de la Santé et de la Recherche Médicale U1083, Centre National de la Recherche Scientifique UMR 6214; Réanimation Médicale et Médicine Hyperbare, LUNAM University, Université d'Angers, Angers, France.
authors: Pierre
authors: P
authors: Asfar
authors: Cardiovascular Surgery, LUNAM University, Université d'Angers, Angers, France; and.
authors: Christophe
authors: C
authors: Baufreton
authors: Department of Anesthesiology. Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands;
authors: Christa
authors: C
authors: Boer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002196:Capillaries / Q000378:metabolism / Q000502:physiology*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D016022:Case-Control Studies; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009060:Mouth Floor / Q000098:blood supply*; D010100:Oxygen / Q000097:blood
chemical_list: D010100:Oxygen
keywords: blood flow velocity; cardiac surgical procedures; microcirculation; oxygen consumption