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Thorac Cardiovasc Surg 2020; 68(04): 282-290
DOI: 10.1055/s-0038-1677511
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Serum Neuron-Specific Enolase Level as Predictor of Neurologic Outcome after Aortic Surgery

Fumiaki Kimura
1   Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
,
Takayuki Kadohama
1   Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
,
Hiroto Kitahara
1   Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
,
Hayato Ise
1   Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
,
Sentaro Nakanishi
1   Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
,
Nobuyuki Akasaka
1   Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
,
Hiroyuki Kamiya
1   Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
› Author Affiliations
Funding The study received no funding from any source.
Further Information

Publication History

24 October 2018

07 December 2018

Publication Date:
22 January 2019 (online)

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Abstract

Background This study aimed to evaluate the significance of serum neuron-specific enolase (NSE) level as a predictor of neurologic injury in thoracic aortic surgery.

Methods We neurologically assessed 60 consecutive patients who underwent thoracic aortic surgery for thoracic aortic aneurysm (n = 26) and aortic dissection (n = 34). Using moderate hypothermic circulatory arrest with antegrade cerebral perfusion, total arch replacement and hemiarch replacement were performed in 37 and 23 patients, respectively. Serum NSE levels in venous blood samples drawn before surgery and at 1 day after surgery were measured. Severity of neurologic injury was categorized as either uncomplicated (n = 48), temporary neurologic dysfunction (TND, n = 5), or permanent neurologic dysfunction (PND, n = 7). The extent of stroke was estimated on computed tomography or magnetic resonance imaging.

Results The NSE level significantly differed among the three groups (PND > TND > uncomplicated) on the first postoperative day. Receiver-operating characteristic curve analysis showed that the cutoff value of NSE level was 34.14 ng/mL for neurologic injury (sensitivity, 0.769; specificity, 0.851) and 43.56 ng/mL for PND (sensitivity, 1.000; specificity, 0.963). The NSE level significantly correlated with the extent of stroke (r = 0.61, p < 0.001).

Conclusion Serum NSE level is a significant predictor of adverse neurologic outcomes and extent of stroke after thoracic aortic surgery.

Keywords

serum neuron-specific enolase - thoracic aortic surgery - temporary neurologic dysfunction - permanent neurologic dysfunction - neurologic injury