Perfusion Temperature During Cardiopulmonary Bypass Does not Affect Serum S-100β Release

Abstract

Background: The potentially harmful effects of normothermia on neurological outcome during cardiopulmonary bypass (CPB) are controversial. Methods: In this study, we compared the early and late release patterns of S-100β, a marker of cerebral injury, after normothermic and moderately hypothermic CPB. Forty-eight patients undergoing coronary artery bypass grafting were randomly assigned to either the normothermia (37 °C) or the hypothermia (32 °C) group. Serum S-100β levels were measured until 24 h after CPB. Neurological examination was performed before and after surgery. Results: With the exception of intraoperative blood glucose levels, there were no differences between groups. This also applied to peak S-100β values (Gr-N: 3.5 ± 1.9 µg/l; Gr-H: 3.5 ± 3.4 µg/l) and values after 24 h (Gr-N: 0.32 ± 0.16 µg/l; Gr-H: 0.35 ± 0.28 µg/l). Conclusions: The similar pattern of S-100β release without evident neurological complications in the normothermia group does not suggest an increase in cerebral injury during normothermic CPB.

Key words

Cardiopulmonary bypass - normothermia - brain injury - biochemical markers - S-100β

References

• 1 The Warm Heart Investigators . Randomised trial of normothermic versus hypothermic coronary bypass surgery.  Lancet. 1994;  343 559-563
• 2 Mora C T, Henson M B, Weintraub W S. et al . The effect of temperature management during cardiopulmonary bypass on neurological and neuropsychologic outcomes in patients undergoing coronary revascularization.  J Thorac Cardiovasc Surg. 1996;  112 514-522
• 3 Martin T D, Craver J M, Gott J P. et al . Prospective, randomized trial of retrograde warm blood cardioplegia: myocardial benefit and neurological threat.  Ann Thorac Surg. 1994;  57 298-302
• 4 Singh A K, Feng W C, Bert A A, Rotenberg F A. Warm body, cold heart surgery. Clinical experience in 2817 patients.  Eur J Cardiothorac Surg. 1993;  7 225-229
• 5 Christenson J T, Maurice J, Simonet F, Velebit V, Schmuziger M. Normothermic versus hypothermic perfusion during primary coronary artery bypass grafting.  Cardiovasc Surg. 1995;  3 519-524
• 6 Craver J M, Bufkin B L, Weintraub W S, Guyton R A. Neurological events after coronary bypass grafting: further observations with warm cardioplegia.  Ann Thorac Surg. 1995;  59 1429-1433
• 7 Ali M S, Harmer M, Vaughan R. Serum S100 protein as a marker of cerebral damage during cardiac surgery.  Br J Anaesth. 2000;  85 287-298
• 8 Taggart D P, Bhattacharya K, Meston N. et al . Serum S-100 protein concentration after cardiac surgery: a randomized trial of arterial line filtration.  Eur J Cardiothor Surg. 1997;  11 645-649
• 9 Westaby S, Johnsson P, Parry A J. et al . Serum S100 protein: a potential marker for cerebral events during cardiopulmonary bypass.  Ann Thorac Surg. 1996;  6 88-92
• 10 Beaudeux J L, Leger P, Dequen L. et al . Influence of hemolysis on the measurement of S-100 beta protein and neuron-specific enolase plasma concentrations during coronary artery bypass grafting.  Clin Chem. 2000;  46 989-990
• 11 Abraha H D, Butterworth R J, Bath P M. et al . Serum S-100 protein, relationship to clinical outcome in acute stroke.  Ann Clin Biochem. 1997;  34 366-370
• 12 Georgiadis D, Berger A, Kowatschev E. et al . Predictive value of S-100 beta and neuron-specific enolase serum levels for adverse neurological outcome after cardiac surgery.  J Thorac Cardiovasc Surg. 2000;  119 138-147
• 13 Kilminster S, Treasure T, McMillan T, Holt D W. Neuropsychological change and S-100 protein release in 130 unselected patients undergoing cardiac surgery.  Stroke. 1999;  30 1869-1874
• 14 Vanninen R, Aikiä M, Könönen M. et al . Subclinical cerebral complications after coronary artery bypass grafting: prospective analysis with magnetic resonance imaging, quantitative electroencephalography, and neuropsychological assessment.  Arch Neurol. 1998;  55 618-627
• 15 Jönsson H, Johnsson P, Alling C. et al . S100beta after coronary artery surgery: release pattern, source of contamination, and relation to neuropsychological outcome.  Ann Thorac Surg. 1999;  68 2202-2208
• 16 Herrmann M, Ebert A D, Galazky I. et al . Neurobehavioral outcome prediction after cardiac surgery: role of neurobiochemical markers of damage to neuronal and glial brain tissue.  Stroke. 2000;  31 645-650
• 17 Jönsson H, Johnsson P, Alling C. et al . Significance of serum S100 release after coronary artery bypass grafting.  Ann Thorac Surg. 1998;  65 1639-1644
• 18 Grimm M, Czerny M, Baumer H. et al . Normothermic cardiopulmonary bypass is beneficial for cognitive brain function after coronary artery bypass grafting - a prospective randomized trial.  Eur J Cardiothorac Surg. 2000;  18 270-275
• 19 Blauth C I. Macroemboli and microemboli during cardiopulmonary bypass.  Ann Thorac Surg. 1995;  59 1300-1303
• 20 Mills S A. Risk factors for cerebral injury and cardiac surgery.  Ann Thorac Surg. 1995;  59 1296-1299
• 21 Grocott H P, Croughwell N D, Amory D W. et al . Cerebral emboli and serum S100beta during cardiac operations.  Ann Thorac Surg. 1998;  65 1645-1649