Protection of the microcirculation during cardiac surgery with cardiopulmonary bypass

Abstract : Cardiac surgery with cardiopulmonary bypass leads to impaired perfusion of the microcirculation, which may be an important contributor to postoperative organ dysfunction. This thesis combines clinical and animal studies that aimed to investigate the mechanisms underlying microcirculatory dysfunction in cardiac surgery with cardiopulmonary bypass. Moreover, we aimed to evaluate two treatments strategies for preservation of microcirculatory perfusion during cardiopulmonary bypass : the use of pulsatile flow as compared to the conventional non pulsatile flow during cardiopulmonary bypass and treatment with imatinib in order to reduce vascular leakage by inhibiting endothelial barrier dysfunction.The current thesis has demonstrated that microcirculatory perfusion is impaired during and after cardiac surgery, and this can be attributed mainly to inflammatory endothelial barrier dysfunction and consequent vascular leakage. Concomitant hemodilution may additionally contribute to reduced microvascular perfusion and oxygenation in on-pumpcardiac surgery. We showed that the use of pulsatile flow during cardiopulmonary bypass improves postoperative microvascular perfusion as compared to non pulsatile flow. Imatinib treatment reduced endothelial barrier dysfunction and vascular leakage in our rat model for cardiopulmonary bypass and resulted in preservation of microcirculatory perfusion andoxygenation during and after extracorporeal circulation.Moreover, imatinib treatment resulted in reduced markers ofrenal, pulmonary and intestinal injury after cardiopulmonary bypass. Based on our findings, reduction of vascular leakage and use of pulsatile flow during cardiopulmonary bypass are promising interventions for the prevention of postoperative complications in patients at risk for organ failure following cardiac surgery with cardiopulmonary bypass.
Document type :
Theses
Complete list of metadatas

Cited literature [355 references]  Display  Hide  Download

https://tel.archives-ouvertes.fr/tel-02188217
Contributor : Abes Star <>
Submitted on : Thursday, July 18, 2019 - 12:11:07 PM
Last modification on : Friday, July 19, 2019 - 1:34:31 AM

File

Koning_these.pdf
Version validated by the jury (STAR)

Identifiers

  • HAL Id : tel-02188217, version 1

Citation

Nick Julius Koning. Protection of the microcirculation during cardiac surgery with cardiopulmonary bypass. Human health and pathology. Université d'Angers; Vrije universiteit (Amsterdam), 2017. English. ⟨NNT : 2017ANGE0073⟩. ⟨tel-02188217⟩

Share

Metrics

Record views

136

Files downloads

55