Protective Efficacy Of Minimally Invasive Techniques On Endothelial Glycocalyx In Aortic Valve Surgery
Serdar Gunaydin1, Kevin McCusker2.
1Numune Training & Research Hospital, Ankara, Turkey, 2New York Medical College, New York, NY, USA.
Objective: The endothelial glycocalyx (EG) is fundamentally involved in numerous physiologic and pathophysiologic actions in the circulatory system. The present study aimed to compare plasma levels of syndecan-1, a biomarker of EG integrity, in patients undergoing minimally invasive aortic valve surgery compared to conventional techniques verified by cell culture. Methods: This prospective cohort study included high-risk patients (Euroscore II >5) undergoing aortic valve surgery between January 2016 and November 2018: Group 1: Minimally Invasive Technique (N=85) and Group 2 (control) N=89. The approach was hemi-median sternotomy and single dose cardioplegia in Group 1 and full sternotomy with intermittent crystalloid cardioplegia in control. Serum Syndecan-1 levels were measured by ELISA via arterial line before (T1) and via coronary sinus sample at the end of the cardiopulmonary bypass (CPB) (T2). A right atrial specimen is collected before and at the end of CPB in each case and processed. Cells were incubated with LPS in culture medium with 2% FCS until 24 h and were routinely grown to 80%-90% confluence. Results:There wasn’t a significant difference between the groups with respect to demographic data, BMI and the change in the troponin-I levels at T1 and T2 (p = 0.162).Postoperative hemorrhage (Group 1: 260 ± 30 and 895 ± 50 mL in control; p=0.032), respiratory support duration (9.5 ± 2 /18 ± 2 h- p=0.041) and ICU stay (1.2±1 vs 2.4±1 days, p=0.045) were significantly better in the Group 1 vs control. No difference in mortality and major complications were noted. Cross clamp time was 71.4±10 in Group 1 and 85±10 min for control (p=0.042). Serum Syndecan-1 concentration is summarized in Table. Microscopic imaging confirmed quantitative results of Syndecan-1 dying with significantly better confluences in minimally invasive group vs control (11650± 3400 vs16450± 3200 RFU, p=0.028). Conclusion: Given its importance, protection of the EG is undoubtedly a promising future target in cardiac operations. Our data underlines the impact of minimally invasive techniques verified by cellular function. A possible association between elevated syndecan-1 levels and postoperative complications needs to be clarified in larger studies. LEGEND: Quantitative Assessment of EG shedding in groups 
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