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Cerebral emboli and serum S100beta during cardiac operations
H P Grocott1, N D Croughwell, D W Amory
1Department of Anesthesiology, Duke Heart Center, Duke University Medical Center, Durham, North Carolina 27710, USA. groco001@mc.duke.edu
Insights
S100beta levels correlate with cerebral microemboli during cardiac surgery, particularly during aortic cannulation. This finding suggests cannulation is a high-risk period for brain injury.
Area of Science:
- Neuroscience
- Cardiovascular Surgery
- Biomarkers
Background:
- S100beta, a glial protein, is a known indicator of cerebral damage.
- Cardiac operations carry a risk of neurological complications due to potential cerebral microemboli.
Purpose of the Study:
- To investigate the relationship between cerebral microemboli and S100beta protein levels during cardiac surgery.
Main Methods:
- Cerebral microemboli were monitored using transcranial Doppler ultrasonography in the middle cerebral artery.
- S100beta levels were measured at multiple time points: baseline, post-cardiopulmonary bypass, and 150/270 minutes after cross-clamp release.
Main Results:
- S100beta levels showed a correlation with age, cardiopulmonary bypass duration, cross-clamp time, and the number of emboli during aortic cannulation (time period 2).
- While cardiopulmonary bypass time was initially associated with S100beta, this association became insignificant in a multivariable model including age and cross-clamp time.
Conclusions:
- The correlation between S100beta levels and emboli during the cannulation phase supports the hypothesis that this period poses a significant risk for cerebral injury during cardiac operations.
Background:
The glial protein S100beta has been used to estimate cerebral damage in a number of clinical settings. The purpose of this investigation was to determine the correlation between cerebral microemboli and S100beta levels during cardiac operations.
Methods:
Transcranial Doppler ultrasonography was used to measure emboli in the right middle cerebral artery. Emboli counts (n = 111) were divided into five time periods: (1) incision to aortic cannulation; (2) aortic cannulation to cross-clamp onset; (3) cross-clamp onset to cross-clamp release; (4) cross-clamp release to decannulation; and (5) decannulation to chest closure. The level of S100beta (n = 156) was measured at baseline, at the end of cardiopulmonary bypass, then 150 and 270 minutes after cross-clamp release.
Results:
The level of S100beta correlated with age, cardiopulmonary bypass time, cross-clamp time, and number of emboli at time period 2. Although cardiopulmonary bypass time was univariately associated with S100beta level, it became nonsignificant in a multivariable model that included age and cross-clamp time.
Conclusions:
The correlation of S100beta level with emboli measured during cannulation (time period 2) supports the hypothesis that cannulation is a high-risk time period for cerebral injury.