Christa Boer, PhD
Associate Professor in Anesthesiology
VU University Medical Center, Amsterdam
In an acute situation of physiological stress, such as a surgical procedure
or cardiopulmonary arrest, the body reacts to maintain perfusion and
oxygenation of vital organs. Depending on patient comorbidity and the
severity of the stress insult, the body may not act accurately, leading to
tissue hypoperfusion. Exposure of vital organs, such as the heart and
kidneys, to severe tissue hypoperfusion is associated with the induction of
metabolic compensatory mechanisms, cellular damage, loss of vascular
integrity and pro- and anticoagulant processes. All may contribute to the
development of complications following surgery.
Our research group demonstrated that alterations in tissue perfusion in patients undergoing
cardiac surgery have deteriorating consequences for microcirculatory blood flow, and lead to
dissociation of endothelial integrity. Moreover, in patients where tissue hypoperfusion results
in hypoxic events, anticoagulant processes may lead to loss of vascular integrity, thereby
contributing to unfavorable outcome. In our preclinical and clinical studies we try to elaborate
what the pathophysiological mechanisms are that trigger loss of vascular integrity in case of
tissue hypoperfusion. Moreover, by investigation of distinct intraoperative hemodynamic
strategies and pharmacological interventions we aim to find new therapeutic options that
might be used to preserve vascular perfusion and function in patients at risk for acute tissue
hypoperfusion.