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Impaired microcirculatory perfusion in a rat model of cardiopulmonary bypass: the role of hemodilution

Koning, N. J., de lange, F., Vonk, A. B. A., Ahmed, Y., van den Brom, C. E., Bogaards, S., van Meurs, M., Jongman, R. M., Schalkwijk, C. G., Begieneman, M. P. V., Niessen, H. W., Baufreton, C. & Boer, C., 1-Mar-2016, In : American Journal of Physiology - Heart and Circulatory Physiology. 310, 5, p. H550-H558 9 p.

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  • Impaired microcirculatory perfusion in a rat model of cardiopulmonary bypass

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DOI

  • Nick J. Koning
  • Fellery de lange
  • Alexander B. A. Vonk
  • Yunus Ahmed
  • Charissa E. van den Brom
  • Sylvia Bogaards
  • Matijs van Meurs
  • Rianne M. Jongman
  • Casper G. Schalkwijk
  • Mark P. V. Begieneman
  • Hans W. Niessen
  • Christophe Baufreton
  • Christa Boer

Although hemodilution is attributed as the main cause of microcirculatory impairment during cardiopulmonary bypass (CPB), this relationship has never been investigated. We investigated the distinct effects of hemodilution with or without CPB on microvascular perfusion and subsequent renal tissue injury in a rat model. Male Wistar rats (375-425 g) were anesthetized, prepared for cremaster muscle intravital microscopy, and subjected to CPB (n = 9), hemodilution alone (n = 9), or a sham procedure (n = 6). Microcirculatory recordings were performed at multiple time points and analyzed for perfusion characteristics. Kidney and lung tissue were investigated for mRNA expression for genes regulating inflammation and endothelial adhesion molecule expression. Renal injury was assessed with immunohistochemistry. Hematocrit levels dropped to 0.24 +/- 0.03 l/l and 0.22 +/- 0.02 l/l after onset of hemodilution with or without CPB. Microcirculatory perfusion remained unaltered in sham rats. Hemodilution alone induced a 13% decrease in perfused capillaries, after which recovery was observed. Onset of CPB reduced the perfused capillaries by 40% (9.2 +/- 0.9 to 5.5 +/- 1.5 perfused capillaries per microscope field; P <0.001), and this reduction persisted throughout the experiment. Endothelial and inflammatory activation and renal histological injury were increased after CPB compared with hemodilution or sham procedure. Hemodilution leads to minor and transient disturbances in microcirculatory perfusion, which cannot fully explain impaired microcirculation following cardiopulmonary bypass. CPB led to increased renal injury and endothelial adhesion molecule expression in the kidney and lung compared with hemodilution. Our findings suggest that microcirculatory impairment during CPB may play a role in the development of kidney injury.

Original languageEnglish
Pages (from-to)H550-H558
Number of pages9
JournalAmerican Journal of Physiology - Heart and Circulatory Physiology
Volume310
Issue number5
Publication statusPublished - 1-Mar-2016

    Keywords

  • acute kidney injury, cardiopulmonary bypass, endothelium, microcirculation, hemodilution, ACUTE KIDNEY INJURY, MEAN ARTERIAL-PRESSURE, CARDIAC-SURGERY, OXYGEN DELIVERY, OFF-PUMP, SUBLINGUAL MICROCIRCULATION, CORONARY REVASCULARIZATION, INFLAMMATORY RESPONSE, EXTREME HEMODILUTION, CAPILLARY DENSITY

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