Heart, Lung and Circulation
Volume 15, Issue 5 , Pages 314-319, October 2006

Does Off-pump Coronary Revascularization Reduce the Release of the Cerebral Markers, S-100β and NSE?

  • Massimo Bonacchi, MD

      Affiliations

    • Cardiac Surgery Department, Policlinico Careggi, Firenze, Italy
    • Corresponding Author InformationCorresponding author at: Divisione di Cardiochirurgia, Policlinico di Careggi, Viale Morgagni, 85, 50134 Careggi Firenze, Italy. Tel.: +39 338 9855 782; fax: +39 05 5794 7458.
    • ,
  • Edvin Prifti, MD

      Affiliations

    • Brigham and Women's Hospital, Harward University, Boston, USA
    • ,
  • Massimo Maiani, MD

      Affiliations

    • Cardiac Surgery Department, Policlinico Careggi, Firenze, Italy
    • ,
  • Fabio Bartolozzi, MD

      Affiliations

    • Cardiothoracic Department, St. James's Hospital, Dublin, Ireland
    • ,
  • Marco Di Eusanio, MD

      Affiliations

    • Department of Cardiovascular Surgery, Santa Maria Hospital, Bari, Italy
    • ,
  • Marzia Leacche, MD

      Affiliations

    • Brigham and Women's Hospital, Harward University, Boston, USA

Received 26 March 2005; received in revised form 4 May 2006; accepted 21 May 2006.

Objectives

The aims of this study were to (1) compare the release of S-100β and NSE in off-pump coronary artery bypass grafting (CABG) versus on-pump surgery; (2) investigate whether the S-100β and NSE serum concentrations correlate with cardiopulmonary bypass (CPB) duration.

Materials and methods

Between October 2002 and May 2004, 42 patients undergoing first time CABG surgery were enrolled in the study. The exclusion criteria were: LVEF<35%, age>70 years, previous myocardial infarction, REDO surgery, the presence of valvular heart disease and/or cerebrovascular disease, abnormal preoperative carotid vessels angiography, coronary artery disease involving the distal circumflex artery, renal dysfunction, coagulopathy. The patients were randomly assigned either to undergo on-pump CABG surgery [group I, n=24 patients] or off-pump CABG [group II, n=18 patients]. Blood was not re-transfused from the cardiotomy suction. All patients presenting haemolysis were excluded from the study.

Results

The preoperative S-100β was 0.13±0.08 (μg/l) and NSE 7±1.5 (μg/l) in group I and 0.12±0.1 (μg/l) and 6.9±2.7 (μg/l), respectively in group II. Six hours after the surgery, S-100β in patients of group I reached a maximum level of 1.38±0.4 (μg/l) and NSE of 17.7±6.5 (μg/l) compared to 0.5±0.11 (μg/l) [S-100B] and NSE 8.6±4.2 (μg/l) in group II (p=0.001). Three (12%) patients in group I and none (0%) in group II suffered postoperative delirium, p=0.247. No strokes occurred linear regression analysis revealed a strong correlation between cardiopulmonary bypass duration and S-100β and NSE peak levels, p<0.0021 (r2=0.36) and p<0.0001 (r=0.81), respectively.

Conclusion

Coronary artery bypass surgery with CPB causes a significantly greater increase in NSE and S-100β serum levels than off-pump surgery and correlates with CPB duration.

Keywords: Off-pump coronary revascularization, Brain impairment, Neurone-specific enolase, S-100B protein

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PII: S1443-9506(06)00118-1

doi:10.1016/j.hlc.2006.05.007

Heart, Lung and Circulation
Volume 15, Issue 5 , Pages 314-319, October 2006

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