Endothelial Glycocalyx and Cardiopulmonary Bypass

Area of Science:

• Biochemistry
• Cell Biology
• Vascular Physiology

Background:

• The endothelial glycocalyx (EGL) is a vital carbohydrate layer on the cell surface.
• It plays critical roles in maintaining vascular integrity, permeability, and acting as a protein reservoir.
• Existing literature has gaps regarding EGL's importance in perfusion and its response to surgical interventions.

Purpose of the Study:

• To provide a comprehensive review of the endothelial glycocalyx.
• To elucidate the impact of EGL on microcirculation, fluid homeostasis, inflammation, and edema during cardiac surgery.
• To bridge the knowledge gap concerning EGL's role in perfusion literature.

Main Methods:

• Literature review of existing studies on endothelial glycocalyx structure and function.
• Analysis of EGL's role in vascular integrity and permeability.
• Examination of factors contributing to EGL damage, such as perioperative fluid management and microemboli.

Main Results:

• The EGL stabilizes the vascular endothelium and acts as a reservoir for plasma proteins.
• It functions as a buffer and mechanotransducer, detecting shear stress.
• Damage to the EGL can cause edema, increased platelet/leukocyte adhesion, and perfusion heterogeneity.

Conclusions:

• Understanding EGL is essential for clinicians to grasp the effects of microbubbles, hyperoxia, and reperfusion injury during cardiac surgery.
• EGL integrity is critical for preventing adverse outcomes like edema and inflammation.
• Further research and clinical attention to EGL are needed, particularly in perioperative care.