• Fu-Quan Fang, Jie-Hao Sun, Qiao-Lin Wu, Lin-Ya Feng, Yu-Xiu Fan, Jun-Xin Ye, Wei Gao, Guo-Liang He, and Wei-Jian Wang.
• From the The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (FQ-F) and The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China (JH-S, QL-W, LY-F, YX-F, JX-Y, W-G, GL-H, WJ-W).
• Eur J Anaesthesiol. 2021 May 1; 38 (5): 477-486.

BackgroundThe glycocalyx plays an important physiological role and may be damaged during cardiopulmonary bypass. Sevoflurane can protect the glycocalyx; however, its relevance in a clinical setting is unknown.ObjectiveGlycocalyx degradation during cardiopulmonary bypass in patients was investigated. On the basis of the available experimental data, we hypothesised that sevoflurane-based anaesthesia would confer additional protection against cardiopulmonary bypass-induced glycocalyx damage.DesignRandomised controlled study.SettingClinical study at The First Affiliated Hospital of Wenzhou Medical University between June 2018 and March 2019.PatientsFifty-one patients.InterventionsAfter intubation and mechanical ventilation, patients undergoing elective heart valve surgery were maintained under general anaesthesia with either propofol or sevoflurane during surgery.Main Outcome MeasuresGlycocalyx markers (such as syndecan-1, heparan sulphate and hyaluronan), sheddases responsible for the degradation of the endothelial glycocalyx (such as matrix metalloproteinase-9 and cathepsin-B), urine albumin-to-creatinine ratio and levels of lactic acid and myocardial enzymes were all measured. Postoperative mechanical ventilation time and length of stay in the cardiac care unit and hospital were also measured. Morbidity and mortality after 30 days and 1 year were evaluated.ResultsThe vascular endothelial glycocalyx was damaged during cardiopulmonary bypass. The glycocalyx damage in the sevoflurane group was less extensive than that in the propofol group. The urine albumin-to-creatinine ratio increased in both groups but was lower in the sevoflurane group. Enzymes including matrix metalloproteinase-9 and cathepsin-B were positively correlated with glycocalyx marker concentrations. After operation, the sevoflurane group showed lower levels of lactic acid and myocardial enzyme, as well as shorter duration of postoperative mechanical ventilation than the propofol group.ConclusionSevoflurane can decrease glycocalyx degradation in patients undergoing heart valve surgery under cardiopulmonary bypass.Trial RegistrationChinese Clinical Trial Registry, chictr.org.cn, identifier: ChiCTR1800016367.Copyright © 2021 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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