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S-100beta release in hypothermic circulatory arrest and coronary artery surgery
C H Wong1, S J Rooney, R S Bonser
1Cardiothoracic Surgical Unit, University Hospital Birmingham, Queen Elizabeth Medical Centre, Edgbaston, United Kingdom.
Insights
S-100beta levels, a marker of brain injury, were significantly higher in patients undergoing aortic surgery with hypothermic circulatory arrest (HCA) compared to coronary artery bypass grafting (CABG). This suggests HCA may cause greater neurological injury, with S-100beta release correlating to procedure duration.
Area of Science:
- Cardiovascular Surgery
- Neurosurgery
- Biomarker Research
Background:
- Aortic surgery using profound hypothermic circulatory arrest (HCA) is associated with a higher incidence of neurological injury compared to coronary artery bypass grafting (CABG).
- S-100beta protein is a potential biomarker for detecting cerebral ischemic injury.
Purpose of the Study:
- To evaluate the utility of S-100beta as a marker for cerebral injury during HCA.
- To compare S-100beta levels in patients undergoing HCA versus CABG.
Main Methods:
- A study involving 40 patients: 10 undergoing CABG and 30 undergoing HCA.
- Measurement of perioperative serum S-100beta levels.
- Analysis of correlations between S-100beta levels and cardiopulmonary bypass (CPB) and HCA durations, with and without retrograde cerebral perfusion (RCP).
Main Results:
- S-100beta levels (peak and area under the curve) were significantly higher in the HCA group compared to the CABG group (p < 0.05).
- Peak S-100beta levels correlated with CPB time in CABG patients and with both CPB and HCA time in HCA patients (with RCP, r=0.88 for CPB, p<0.05).
- No significant difference in S-100beta levels was observed between HCA groups with and without RCP, despite longer HCA duration in the RCP group.
Conclusions:
- S-100beta release is associated with the duration of CPB and HCA, indicating astrocyte damage or activation and potential blood-brain barrier dysfunction.
- Elevated S-100beta levels post-operation suggest that HCA may lead to more significant cerebral injury than CABG.
- Retrograde cerebral perfusion (RCP) did not appear to influence S-100beta release in this study.
Background:
Aortic surgery utilizing profound hypothermic circulatory arrest (HCA) has a higher incidence of neurological injury than coronary artery bypass grafting (CABG). S-100beta is a potential marker of cerebral ischemic injury. The aim of this study is to assess its use in investigating cerebral injury during HCA.
Methods:
We studied 40 patients (10 CABG, 30 HCA). The mean cardiopulmonary bypass (CPB) times were 72 and 158 minutes, respectively. Mean HCA duration was 27.6 min, with retrograde cerebral perfusion (RCP) used in 18 patients (mean 28.5 minutes, 95% CI 16-25). Perioperative venous blood samples were subjected to S100beta assay.
Results:
S100beta levels with HCA (peak: 2.68 microg/L, 95% CI 1.99-3.38 microg/L; calculated area under the curve [AUC]: 1596 microg/L/min, 95% CI 825-2368 microg/L/min) were significantly higher (peak, p = 0.028 and AUC, p = 0.007) than with CABG (peak: 1.16 microg/L, 95% CI 0.25-2.1 microg/L and AUC: 53.4 microg/L/min 95% CI 3.0-103.8). Peak S100beta correlated with CPB time in CABG cases (r = 0.76, p < 0.05), and with both CPB and HCA time in HCA cases: without RCP (r = 0.46 and 0.21, respectively, p > 0.05) and with RCP (r = 0.88 and 0.33, respectively, p < 0.05). There was no significant difference in the S100beta levels between HCA groups with and without RCP, but HCA time was longer in the RCP group (p = 0.05).
Conclusions:
S100beta release correlates with duration of CPB and HCA. Elevated serum S100 indicates astrocyte death or activation, and suggests blood-brain barrier dysfunction. The continuing release of S100 after the end of operation suggests that HCA may be associated with greater injury than CABG. RCP did not influence S-100beta release in this study.