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Serum S-100beta protein release in coronary artery bypass grafting: laminar versus pulsatile flow
1Clinic for Cardiac Surgery, Philipps University Hospital, Marburg, Germany.
Insights
Pulsatile cardiopulmonary bypass (CPB) may offer better neuroprotection than laminar flow during coronary artery bypass grafting (CABG). Lower S-100beta serum marker levels suggest reduced cerebral injury with pulsatile flow.
Area of Science:
- Cardiovascular Surgery
- Neuroprotection
- Biomarkers
Background:
- Cerebral injury is a significant complication following cardiopulmonary bypass (CPB).
- The S-100beta serum marker is a potential indicator of cerebral injury during and after CPB.
- Limited research directly compares laminar versus pulsatile pump flow effects on S-100beta levels and neuroprotection in CABG.
Purpose of the Study:
- To compare S-100beta serum levels in patients undergoing CABG with laminar versus pulsatile pump flow.
- To investigate the potential neuroprotective effects of pulsatile pump flow during CPB.
Main Methods:
- A study involving 21 first-time CABG patients without prior cerebral disease.
- Patients were divided into two groups: laminar flow (n=10) and pulsatile flow (n=11) using a Stöckert roller pump.
- Serum S-100beta levels were measured using a monoclonal immunoradiometric assay at five time points, from pre-intubation to 36 hours post-surgery.
Main Results:
- Peak S-100beta levels were observed at skin closure.
- Median S-100beta levels were lower in the pulsatile flow group compared to the laminar flow group.
- The study's small sample size and wide data range resulted in non-significant findings.
Conclusions:
- Pulsatile pump flow during CPB may offer a more neuroprotective effect than laminar flow.
- Lower S-100beta values in the pulsatile group suggest a potential benefit in reducing cerebral injury.
Background:
Cerebral injury after Cardiopulmonary bypass (CPB) is still a serious and unpredictable complication. The S-100beta serum marker has been suggested as potentially useful in the detection of cerebral injury during and after CPB. Direct comparisons of whether laminar or pulsatile pump flow in CABG leads to higher S-100beta values and which type might be more neuroprotective have not been made so far.
Methods:
All 21 patients of the study were undergoing CABG for the first time and had no history of cerebral disease in whatever form. They were divided into two groups: laminar (n = 10) versus pulsatile (n = 11) pump flow. In all cases, a Stöckert roller pump (Fa. Stöckert, Munich, Germany) with a laminar and pulsatile running mode was used for cardiopulmonary bypass. Serum S-100beta levels were detected using a monoclonal immunoradiometric assay (Sangtec Medical AB, Bromma, Sweden). In total, 5 different samples were drawn per patient, starting before intubation and ending 36 hours after surgery.
Results:
S-100beta peak values were found at skin closure. Median levels were lower in the pulsatile group. Due to the small study group and wide range, results are non-significant.
Conclusion:
The results indicate that pulsatile flow might have a more neuroprotective effect than laminar flow as S-100beta values were lower.
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