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Ann Thorac Surg 2001;71:2085
© 2001 The Society of Thoracic Surgeons

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Correspondence

S100 release as an indicator of cerebral damage

^a The University College London Hospitals, Holmes Sellors Cardiothoracic Unit, The Middlesex Hospital, London, England, United Kingdom

e-mail: rmhkdcw{at}ucl.ac.uk

To the Editor

The recent suggestion by Wandschneider and colleagues [1] that avoiding cardiopulmonary bypass reduces perioperative cerebral injury remains an interesting hypothesis that has yet to be adequately tested. The hypothesis does not, however, seem to be supported by data from their study. For several reasons, serum S100ß is a controversial marker of cerebral injury during cardiac operation. These are not addressed in the article. First, although widely used, the Sangtec assay remains unvalidated by published data [2]. There are theoretical concerns regarding the specificity of this assay for neuronal damage in the context of cardiac operation when other tissues such as the heart and mediastinum are damaged and may also release S100. Such concerns are supported by data showing that the use of cardiotomy suction without cell washing can greatly affect serum S100 levels [3]. Therefore, any studies measuring S100 must control or eliminate cardiotomy suction and blood recycling. Wandschneider and associates do not state whether cardiotomy suction was used in the cardiopulmonary bypass group, cell savers in the off cardiopulmonary bypass group, or whether cell washing occurred in either group. Therefore, it is possible that the increase in S100 found in the cardiopulmonary bypass group reflects cardiotomy-generated S100 and not cerebral injury. Cardiotomy suction would tend to produce such an early peak at up to 6 hours after operation rather than the later peak at 24 hours, which is more strongly associated with cerebral injury.

With regard to other measures of cerebral damage, Wandschneider and colleagues are correct to state that the low incidence of strokes after coronary artery bypass grafting makes strokes difficult to study but misleading to dismiss neurocognitive deficits as "even harder to evaluate and results differ widely." The incidence of such strokes reported in the literature varies as widely as neuropsychologic deficits [4]. Using the correct methods of testing, neuropsychologic testing is reliable and reproducible, although the statistical analysis requires care (and usually the help of a statistician). Neuropsychologic testing remains the gold standard of evaluating diffuse cerebral injury, whereas S100 is still an unknown quantity. It must also be remembered that strokes and diffuse cerebral injury are separate entities (with some possible overlap in etiology) and studies must be differently designed to test one or the other.

In addition, it would have been useful to know the temperature characteristics of the off-pump group as temperature control may affect cerebral injury.

References

1. Wandschneider W., Thalmann M., Trampitsch E., Ziervogel G., Kobinia G. Off-pump coronary bypass operations significantly reduce S100 release: an indicator for less cerebral damage?. Ann Thorac Surg 2000;70:1577-1579.[Abstract/Free Full Text]
2. Pisa E.K. Serum S-100 protein in stroke and cardiac surgery. Stroke 1999;30:1153.[Free Full Text]
3. Anderson R.E., Hansson L., Liska J., Settergren G., Vaage J. The effect of cardiotomy suction on the brain injury marker S100ß after cardiopulmonary bypass. Ann Thorac Surg 2000;69:847-850.[Abstract/Free Full Text]
4. McGhann G.M., Goldsborough M.A., Borowicz L.M., Jr, et al. Predictors of stroke risk in coronary artery bypass patients. Ann Thorac Surg 1997;63:516-521.[Abstract/Free Full Text]

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Whitaker, D. Search for Related Content PubMed PubMed Citation Articles by Whitaker, D. Related Collections Cerebral protection Related Article