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S100B increases in cyanotic versus noncyanotic infants undergoing heart surgery and cardiopulmonary bypass (CPB)
Alessandro Varrica1, Angela Satriano1, Antonio D W Gavilanes2
1a Department of Pediatric Cardiac Surgery IRCCS San Donato Milanese Hospital , San Donato Milanese , Italy.
Insights
Infants with cyanotic congenital heart disease (CHDc) show higher S100B brain damage markers during heart surgery. Further research is needed to optimize oxygen levels during cardiopulmonary bypass (CPB) to minimize brain stress.
Area of Science:
- Biomedical Science
- Pediatric Cardiology
- Neuroscience
Background:
- S100B protein is a potential biomarker for brain injury.
- Congenital heart disease (CHD) infants undergoing cardiac surgery with cardiopulmonary bypass (CPB) are at risk for neurological complications.
- Cyanotic CHD (CHDc) may influence perioperative brain stress.
Purpose of the Study:
- To compare S100B blood levels in infants with and without cyanotic CHD during the perioperative period.
- To investigate the correlation between S100B levels and intraoperative oxygenation (PaO2) in these infants.
Main Methods:
- A case-control study involving 48 infants with CHD undergoing surgery and CPB.
- 24 infants had CHDc, and 24 served as controls.
- S100B levels were measured at six time-points from before surgery to 24 hours post-surgery.
Main Results:
- S100B levels were significantly higher in the CHDc group throughout the perioperative period.
- CHDc infants had lower PaO2 at specific time-points but not during CPB.
- A positive correlation was found between S100B levels and PaO2 at the end of CPB.
Conclusions:
- Infants with CHDc experience greater perioperative brain stress, indicated by elevated S100B.
- These findings highlight the potential vulnerability of CHDc infants to hypoxia/hyperoxia-mediated brain effects.
- Further studies are warranted to determine optimal PaO2 targets during CPB to mitigate reoxygenation-related side effects.
Aims:
S100B has been proposed as a consolidated marker of brain damage in infants with congenital heart disease (CHD) undergoing cardiac surgery and cardiopulmonary bypass (CPB). The present study aimed to investigate whether S100B blood levels in the perioperative period differed in infants complicated or not by cyanotic CHD (CHDc) and correlated with oxygenation status (PaO2).
Methods:
We conducted a case-control study of 48 CHD infants without pre-existing neurological disorders undergoing surgical repair and CPB. 24 infants were CHDc and 24 were CHD controls. Blood samples for S100B assessment were collected at six monitoring time-points: before the surgical procedure (T0), after sternotomy but before CPB (T1), at the end of the cross-clamp CPB phase (T2), at the end of CPB (T3), at the end of the surgical procedure (T4), at 24 h postsurgery (T5).
Results:
In the CHDc group, S100B multiples of median (MoM) were significantly higher (p < .05, for all) from T0 to T5. PaO2 was significantly lower (p < .05, for all) in CHDc infants at T0-T1 and at T4 while no differences (p > .05, for all) were found at T2, T3, T5. Linear regression analysis showed a positive correlation between S100B MoM at T3 and PaO2 (R = 0.84; p < .001).
Conclusions:
The present data showing higher hypoxia/hyperoxia-mediated S100B concentrations in CHDc infants suggest that CHDc are more prone to perioperative brain stress/damage and suggest the usefulness of further investigations to detect the "optimal" PaO2 target in order to avoid the side effects associated with reoxygenation during CPB.
