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Ann Thorac Surg 1999;67:1911-1914
© 1999 The Society of Thoracic Surgeons

S-100ß release in hypothermic circulatory arrest and coronary artery surgery

^a Cardiothoracic Surgical Unit, University Hospital Birmingham, Queen Elizabeth Medical Centre, Edgbaston, Birmingham, United Kingdom

Address reprint requests to Mr Bonser, Cardiothoracic Surgical Unit, University Hospital Birmingham, Queen Elizabeth Medical Centre, Edgbaston, Birmingham B15 2TH, UK
e-mail: r.s.bonser{at}bham.ac.uk

Presented at the Aortic Surgery Symposium VI, April 30–May 1, 1998, New York, NY.

Background. Aortic surgery utilizing profound hypothermic circulatory arrest (HCA) has a higher incidence of neurological injury than coronary artery bypass grafting (CABG). S-100ß is a potential marker of cerebral ischemic injury. The aim of this study is to assess its use in investigating cerebral injury during HCA.

Methods. We studied 40 patients (10 CABG, 30 HCA). The mean cardiopulmonary bypass (CPB) times were 72 and 158 minutes, respectively. Mean HCA duration was 27.6 min, with retrograde cerebral perfusion (RCP) used in 18 patients (mean 28.5 minutes, 95% CI 16–25). Perioperative venous blood samples were subjected to S100ß assay.

Results. S100ß levels with HCA (peak: 2.68 µg/L, 95% CI 1.99–3.38 µg/L; calculated area under the curve [AUC]: 1596 µg/L/min, 95% CI 825–2368 µg/L/min) were significantly higher (peak, p = 0.028 and AUC, p = 0.007) than with CABG (peak: 1.16 µg/L, 95% CI 0.25–2.1 µg/L and AUC: 53.4 µg/L/min 95% CI 3.0–103.8). Peak S100ß correlated with CPB time in CABG cases (r = 0.76, p < 0.05), and with both CPB and HCA time in HCA cases: without RCP (r = 0.46 and 0.21, respectively, p > 0.05) and with RCP (r = 0.88 and 0.33, respectively, p < 0.05). There was no significant difference in the S100ß levels between HCA groups with and without RCP, but HCA time was longer in the RCP group (p = 0.05).

Conclusions. S100ß release correlates with duration of CPB and HCA. Elevated serum S100 indicates astrocyte death or activation, and suggests blood-brain barrier dysfunction. The continuing release of S100 after the end of operation suggests that HCA may be associated with greater injury than CABG. RCP did not influence S-100ß release in this study.

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