|
CARDIOVASCULAR
|
Volume 5, 2000, No 3 |
Serum
S-100 Protein Release and Regional Cerebral Oxygen Saturation Course in the
Aortic Surgery Using Hypothermic Circulatory Arrest with Retrograde Cerebral
Perfusion
Y. Bonkohara, K. Minami, D. Böthig, R. Körfer
Background: Hypothermic cardiac arrest (HCA) with retrograde cerebral perfusion (RCP) for aortic surgery has been widely accepted. However, postoperative neurological complications are still great concerns. The serum S-100 protein has been expected to be a reliable marker for brain damage, and regional cerebral oxygen saturation (rSO2) has been used for a brain-monitoring during HCA. In this study we assessed the meaning of S-100 and rSO2 for neurological outcomes after aortic surgery using HCA with RCP.
Methods: We analysed 31 patients who underwent aortic surgery using HCA with RCP. The rSO2 was measured in all patients during the operation and S-100 was measured before skin incision, before cardiopulmonary bypass (CPB), before HCA, after HCA, at the end of CPB, at 4, 24 hours and 4 days after the operation. We evaluated perioperative data related to postoperative neurological dysfunctions.
Results: There was 1 early death and 1 late death. Twenty-one patients had no neurological complications (group I), 5 had temporary neurological (group II), and 5 permanent dysfunction (group III). The HCA time ranged from 11 to 73 minutes (mean 29.7 + 17.2 minutes). The time of rSO2 under 30% correlated with HCA time (r=0.579, p=0.002). The S-100 of 4 days postoperatively in group III was significantly higher than group I and group II (p=0.0031). The CPB time and aortic cross clamping (AOX) time in group II was significantly longer than group I (p=0.043, p=0.013, respectively), however, HCA time was not significantly different. There were no such differences between group I and group III.
Conclusion: The rSO2 was decreasing during HCA and the duration of rSO2 under 30% correlated with HCA time. The elevation of S-100 on postoperative day 4 might indicate permanent brain damage. The HCA with RCP for about 30 minutes was no risk for the postoperative neurological disorder, however, prolonged CPB and AOX time were related to temporary neurological dysfunction.
(CVE. 2000; 5 (3): 234-239)
Key words: hypothermic circulatory arrest, retrograde cerebral perfusion, serum S-100 protein, regional cerebral oxygen saturation, neurological dysfunction
Professor
Kazutomo Minami, M.D., Ph.D.
Herzzentrum NRW
Georgstr. 11
D-32545 Bad Oeynhausen
Germany
PABST SCIENCE PUBLISHERS
Lengerich, Berlin, Riga, Rom,
Wien, Zagreb