Impact of Perioperative Shedding of the Endothelial Glycocalyx on the Incidence of Postoperative Acute Kidney Injury in Patients Undergoing Valvular Heart Surgery.

Study Overview
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Brief Summary
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Endothelial glycocalyx, the luminal structure of healthy vasculature, plays critical roles in regulation of inflammatory responses, vascular permeability, blood coagulation. It can be easily damaged by ischemia/reperfusion, hypoxemia, oxidative stress, endotoxin. Accordingly, the relationship between the shedding of endothelial glycocalyx and the prognosis of diseases such as diabetes mellitus, atherosclerosis, malignancy has been researched. In cases of cardiac surgery, patients cannot help but be exposed to ischemia/reperfusion, oxidative stress which can damage endothelial glycocalyx. In this research, the investigators would like to discover the impact of perioperative shedding of the endothelial glycocalyx on the incidence of postoperative acute kidney injury in patients undergoing valvular heart surgery.

Detailed Description
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Syndecan-1, Heparan sulfate serve as biomarkers of glycocalyx degradation. Both biomarkers will be measured 2 times, before the anesthetic induction, and immediately after weaning from cardiopulmonary bypass, during the valvular heart surgery. Postoperative acute kidney injury up to postoperative 48 hours, Composite morbidity and mortality up to postoperative 30 days will be checked.

Official Title
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Impact of Perioperative Shedding of the Endothelial Glycocalyx on the Incidence of Postoperative Acute Kidney Injury in Patients Undergoing Valvular Heart Surgery.

Conditions
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Valvular Heart Disease

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: - Patients undergoing valvular heart surgery (>20 years old) Exclusion Criteria: Emergency operation Aorta surgery (Graft replacement of Total arch or Descending thoracic aorta) Minimal invasive surgery Chronic kidney disease (eGFR<30mL/min/1.73m2) / Dialysis history Infective endocarditis Malignancy Patients who cannot give Informed consent (e.g. Illiterate, Foreigners) Patients who are already enrolled to another study than can affect the results

Ages Eligible for Study
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Minimum Age: 20 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Q1<br>Measure the Concentration of Syndecan-1, Heparan sulfate before anesthetic induction and immediately after weaning from cardiopulmonary bypass. Categorize the patients by serum syndecan-1 concentration(off-CPB) quartile. Q1 means a group of lowest 25% of serum syndecan-1 concentration. | |
| Q2<br>Q2 means a group of lower 25 50% of serum syndecan-1 concentration. | |
| Q3<br>Q3 means a group of higher 50 75% of serum syndecan-1 concentration. | |
| Q4<br>Q4 means a group of highest 75 100% of serum syndecan-1 concentration. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Acute kidney injury | Acute kidney injury is classified under KDIGO guideline. Stage I Serum creatinine (Scr) : 1.5 to 1.9 times baseline or ≥26μmol/L (≥3.0mg/dL) increase Urine output : <0.5mL/kg/kr for 6 12hrs Stage II Serum creatinine (Scr) : 2.0 to 2.9 times baseline Urine output : <0.5mL/kg/hr for ≥12hrs Stage III Serum creatinine (Scr) : 3.0 times baseline or ≥354μmol/L (≥4.0mg/dL) increase or Initiation for RRT Urine output : <0.3mL/kg/hr for ≥24hrs or Anuria for ≥12hrs | Up to Postoperative 48 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Composite morbidity and mortality (by STS Major morbidity endpoint) | STS Major morbidity endpoint Mortality for postoperative 30 days irrelevant to causes Permanent stroke Wound infection Prolonged ventilation greater than 48 hours Cardiac surgery reoperation | Up to postoperative 30 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Endothelial glycocalyx, Acute kidney injury, Valvular heart disease