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Ann Thorac Surg 1999;68:2202-2208
© 1999 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

S100ß after coronary artery surgery: release pattern, source of contamination, and relation to neuropsychological outcome

Henrik Jönsson, MDa, Per Johnsson, MD, PhDa, Christer Alling, MD, PhDa, Martin Bäckström, PhDa, Cecilia Bergh, MSca, Sten Blomquist, MD, PhDa

a Departments of Cardiothoracic Surgery and Medical Neurochemistry and Institute of Laboratory Medicine, University Hospital Lund, Lund, Sweden

Address requests for reprints to Dr Jönsson, Department of Cardiothoracic Surgery, University Hospital Lund, SE-221 85 Lund, Sweden
e-mail: henrik.jonsson{at}thorax.lu.se

Background. S100ß has been suggested as a marker of brain damage after cardiac operation. The aim of this study was to characterize the early S100ß release in detail and relate it to neuropsychological outcome.

Methods. Three groups of patients were investigated. All patients underwent coronary artery bypass surgery (CABG) with extracorporeal circulation. In group A, 110 patients had sampling of S100ß for the first 10 postoperative hours and also underwent neuropsychological testing. In group B, 14 patients were examined for the effect of autotransfusion on S100ß levels. Eight patients in group C had their intraoperative bleeding processed with a cell-saving device.

Results. Group A had a heterogeneous release pattern with several rapid elevations in S100ß concentration. In group B, high concentrations of S100ß were found in the autotransfusion blood (range 0.2 to 210 µg/L) with a concurrent elevation of serum S100ß levels after transfusion of shed blood. In group C, high levels of S100ß were found in the blood from the surgical field (12.0 ± 6.0 µg/L) and decreased (1.1 ± 0.64 µg/L) after wash. Group C had significantly lower S100ß values at the end of cardiopulmonary bypass compared to group A (0.53 ± 0.35 µg/L versus 2.40 ± 1.5 µg/L). S100ß values were corrected for extracerebral contamination with a kinetic model. With this correction, an association was found between adverse neuropsychological outcome and S100ß release in group A (r = 0.39, p < 0.02).

Conclusions. A significant amount of S100ß is found both in the blood from the surgical field and in the shed mediastinal blood postoperatively. Infusion of this blood will result in infusion of S100ß into the blood and interfere in the interpretation of early systemic S100ß values.




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