D. Bruegger, M. Rehm, J. Abicht
Dec 1, 2009
The Journal of thoracic and cardiovascular surgery
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. This large structure maintains the physiologic permeability barrier and prevents leukocyte and platelet adhesion, thereby mitigating inflammation and tissue edema. 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. 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.