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Serum S100 protein as a marker of cerebral damage during cardiac surgery
1Department of Anaesthetics and Intensive Care Medicine, University of Wales College of Medicine, Cardiff, UK.
Insights
S100 protein is an early serum marker for cerebral damage following cardiac surgery. Its levels correlate with cardiopulmonary bypass duration and are linked to neurological complications, but can be reduced with specific circuit modifications.
Area of Science:
- Neurology
- Cardiology
- Biochemistry
Background:
- Cerebral injury is a significant concern following cardiac surgery.
- Identifying reliable serum markers for brain damage is crucial for patient management.
Purpose of the Study:
- To evaluate S100 protein as a serum marker for cerebral injury after cardiac surgery.
- To investigate the correlation between S100 protein levels and surgical factors, patient characteristics, and neurological outcomes.
Main Methods:
- Serum S100 protein levels were measured in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).
- Correlations were analyzed between S100 protein levels and CPB duration, circulatory arrest, aortic cross-clamping, patient age, microemboli, and neurological complications.
Main Results:
- S100 protein is released after CPB and its levels correlate with CPB duration, circulatory arrest, and aortic cross-clamping.
- Increased S100 protein levels are associated with patient age, microemboli, and perioperative cerebral complications like stroke and delayed awakening.
- Specific interventions, including arterial line filtration and heparin-coated circuits, reduced S100 protein levels.
Conclusions:
- S100 protein serves as an early indicator of cerebral damage and perioperative complications after cardiac surgery.
- Factors like CPB duration and patient age influence S100 protein release.
- Technological advancements in CPB circuits can mitigate S100 protein elevation, suggesting reduced brain injury.
Abstract:
The identification of a serum marker to assist in the diagnosis of cerebral injury after cardiac surgery is potentially useful. S100 protein is an early marker of cerebral damage. It is released after cardiac surgery performed under cardiopulmonary bypass (CPB). Its level is correlated with the duration of CPB, deep circulatory arrest and aortic cross-clamping. Increased levels of S100 protein are correlated with the age of the patient and the number of microemboli, especially during aortic cannulation. Perioperative cerebral complications such as stroke, delayed awakening and confusion are associated with increased levels of S100 protein directly after bypass and from 15 to 48 h after it. In addition, increased levels of S100 protein are related to neuropsychological dysfunction after cardiac surgery. S100 protein has early and late release patterns after CPB; the early pattern may be due to sub-clinical brain injury. The late release pattern may be due to perioperative cerebral complications. Patients undergoing intracardiac operations combined with coronary artery bypass surgery are more susceptible to brain injury and have higher levels of S100 after CPB. Furthermore, adults and children undergoing deep circulatory arrest are more susceptible to brain injury, in terms of higher S100 protein release after CPB. Serum S100 protein levels are reduced after using arterial line filtration and covalent-bonded heparin to coat the inner surface of the CPB circuit.