Comparison of Microcirculatory Perfusion in Obese and Non-Obese Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass

Abstract

Obesity is a frequent comorbidity among patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Cardiac surgery with CPB impairs microcirculatory perfusion, which is associated with multiple organ failure. As microvascular function is frequently compromised in obese patients, we studied whether cardiac surgery with CPB has a more detrimental effect on microcirculatory perfusion in obese patients. Sublingual microcirculatory perfusion was measured with sidestream dark field (SDF) imaging in obese patients (body mass index ≥32 kg/m2; n = 14) without type II diabetes mellitus and in lean patients (BMI 20–25 kg/m2; n = 22) undergoing cardiac surgery with CPB. CPB reduced systolic blood pressure and mean arterial pressure more profoundly in lean compared with obese patients (SBP: 38% vs. 18%; MAP: 11% vs. 8%, p < 0.05), and both restored after weaning from CPB. No differences were present in intraoperative glucose, hematocrit, hemoglobin, lactate, and blood gas values between obese and lean patients. Microcirculatory perfusion did not differ between obese and lean patients the day before surgery. CPB decreased microcirculatory perfusion with 9% in both groups, but this was only significant in lean patients (p < 0.05). Three days following surgery, microcirculatory perfusion was restored in both groups. In conclusion, microcirculatory perfusion was equally disturbed during cardiac surgery with CPB in metabolically healthy obese patients compared to lean patients.

Characteristics of sublingual microcirculatory changes during the early postoperative period following cardiopulmonary bypass-assisted cardiac surgery—a prospective cohort study

“…There are conflicting reports concerning the influence of CPB on MFI. Some studies have reported that MFI increased compared with the baseline after the start of CPB during surgery ( 18 , 21 ), while some did not observe this effect during cardiac surgery ( 20 , 22 , 23 ), and others reported that MFI significantly decreased compared with the baseline during ICU follow-up ( 24 , 25 ). It is speculated that the current measurement method of MFI only reflects the abnormal flow of slow microcirculation and does not consider the abnormal flow of hyperdynamic microcirculation.…”

Leptina, obesidad y enfermedades cardiovasculares

“…Una serie de estudios han establecido que la obesidad también se asocia con cambios en la función vascular dentro del TA, ya que produce alteraciones en los capilares tisulares, lo que conduce a hipoxia localizada. 18,19 No obstante, un informe demostró que los sujetos obesos tienen aumento en lugar de disminución de la tensión de oxígeno dentro del TA, a pesar de la reducción del flujo sanguíneo. 20 Se debe señalar que este último estudio no descarta la posibilidad de zonas de hipoxia localizadas.…”

“…Diversos hallazgos coinciden en que la disminución de la cantidad y la alteración de la función de los capilares dentro del TA puede limitar el aporte de nutrientes y contribuir a la insulinorresistencia. 18 En forma alternativa, esta disfunción vascular podría contribuir a la inflamación, provocando necrosis y muerte de los adipocitos inducida por isquemia, seguida por inclusión y activación de los macrófagos.…”

Testicular ultrasonic microvascular density in assessing spermatogenesis and predicting successful sperm retrieval

“…Testicular microcirculation disorders are not uncommon in clinical practice, most commonly in varicocele ( 7 ), but also in chronic diseases that cause systemic microcirculation disorders. The relationship between microcirculation disorders and chronic diseases has been a hot topic of ongoing research ( 8 , 9 ), and the relationship between microcirculation disorders and testicular spermatogenesis is an area of ongoing interest to urologists, but research into testicular microcirculation is still in an exploratory phase due to the specific anatomy of the testis and the limitations of technology. It has been reported that better-quality sperm tend to be found in areas of the testis with more abundant blood perfusion ( 10 ).…”