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1 . 2023

Influence of gas microembolism on plasma concentration of protein S-100 and neurospecific enolase during open heart surgery under cardiopulmonary bypass

Abstract

According to most authors, one of the main causes of neurological complications after operations performed under EC conditions is cerebral gas embolism with subsequent impairment of cerebral perfusion and damage to the nervous tissue.

Aim. Evaluate the dynamics of S-100 and NSE during the operation. To study the correlation between the volume of GME and the concentration of S-100 and NSE in blood serum.

Material and methods. The study included 36 patients operated on for acquired heart disease, coronary artery disease and aortic aneurysm. The exclusion criterion was the presence of a history of stroke, TBI and cognitive impairment.

Results. It was found that the concentration of S-100 and NSE at point B was higher than at point A. The Spearman rank correlation coefficient between the number of registered gas microemboli in arterial blood and the concentration of S-100 was 0.36 (p<0.05), and between NSE and the number of registered gas microemboli was 0.44 (p<0.05).

Conclusion. Plasma concentration of protein S-100 and NSE in the postoperative period in patients operated under EC conditions is higher than at the beginning of the operation. Plasma concentration of S-100 and NSE has a weak direct correlation with the volume of registered GME.

Keywords:S-100; NSE; gas microemboly; cardiopulmonary bypass; extracorporeal circle

Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Panov A.V., Lokshin L.S., Gubko A.V. Influence of gas microembolism on plasma concentration of protein S-100 and neurospecific enolase during open heart surgery under cardiopulmonary bypass. Clinical and Experimental Surgery. Petrovsky Journal. 2023; 11 (1): 121–5. DOI: https://doi.org/10.33029/2308-1198-2023-11-1-121-125  (in Russian)

References

1.    Berikashvili L.B., Kuzovlev A.N., Yadgarov M.Ya., Kadantseva K.K., Ozhiganova E.A., Likhvantsev V.V. The predictive ability of the M nomogram regarding serious adverse cardiac and cerebral events after elective cardiac operations performed under cardiopulmonary bypass. Bulletin of Anesthesiology and Resuscitation. 2022; 19 (2): 6–13. DOI: https://doi.org/10.21292/2078-5658-2022-19-2-6-13  (in Russian)

2.    Ivkin A.A., Grigor’ev E.V., Shukevich D.L. The role of cardiopulmonary bypass in the development of postoperative cognitive dysfunction. Cardiology and Cardiovascular Surgery. 2021; 14 (2): 168–74. DOI: https://doi.org/10.17116/kardio202114021168  (in Russian)

3.    Russell M.D., Pinkerton C., Sherman K.A., Ebert T.J., Pagel P.S. Predisposing and Precipitating factors associated with postoperative delirium in patients undergoing cardiac surgery at a Veterans Affairs Medical Center: A pilot retrospective analysis. Cardiothorac Vasc Anesth. 2020; 34 (8): 2103–11. DOI: https://doi.org/10.1053/j.jvca.2020.02.004

4.    Liu Y.H., Wang D.X., Li L.H., Wu X.M., Shan G.J., Su Y., et al. The effects off cardiopulmonary bypass on the number of cerebral microemboli and the incidence of cognitive dysfunction after coronary artery bypass graft surgery. Anesth Analg. 2009; 109 (4): 1013–22. DOI: https://doi.org/10.1213/ane.0b013e3181aed2bb

5.    van Dijk D., Kalkman C.J. Why are cerebral microemboli not associated with cognitive decline? Anesth Analg 2009; 109 (4): 1006–8. DOI: https://doi.org/10.1213/ANE.0b013e3181b5af06

6.    de Somer F.M., Vetrano M.R., Van Beeck J.P., Van nooten G.J. Еxtracorporeal bubbles: a word of caution. Interact Cardiovasc Thorac Surg. 2010; 10: 995–1001. DOI: https://doi.org/10.1510/icvts.2009.229088

7.    Reis E.E., Menezes L.D., Justo C.C.L. Gaseous microemboli in cardiac surgery with cardiopulmonary bypass. Rev Bras Cir Cardiovasc. 2012; 27 (3): 436–45. DOI: https://doi.org/10.5935/1678-9741.20120073

8.    Stehouwer M.C., de Vroege R., Bruggemans E.F., Hofman F.N., Molenaar M.A., van Oeveren W., et al. The influence of gaseous microemboli on various biomarkers after minimized cardiopulmonary bypass. Perfusion. 2020; 35 (3): 202–8. DOI: https://doi.org/0.1177/0267659119867572

9.    Suzuki A., Armstead S.C., Eckmann D.M. Surfactant reduction in embolism bubble adhesion and endothelial damage. Anesthesiology. 2004; 101: 97–103. DOI: https://doi.org/10.1097/00000542-200407000-00016

10.                   Tingleff J., Joyce F.S., Pettersson G. Intraoperative echocardiographic study of air embolism during cardiac operations. Ann Thorac Surg. 1995; 60: 673–7. DOI: https://doi.org/10.1016/0003-4975(95)00577-8

11.                   Toomasian C.J. The effect of air exposure on leucocyte and cytokine activation in an in-vitro model of cardiotomy suction. Perfusion. 2018; 33: 538–45. DOI: https://doi.org/10.1177/s00401-010-0674-1

12.                   Anderson R.E., Hansson L.O., Nilsson O., et al. High serum S100B levels from trauma patients without head injuries. Neurosurgery. 2001; 48 (6): 1255–8. DOI: https://doi.org/10.1097/00006123-200106000-00012

13.                   Westaby S., Johnsson P., Parry A.J., et al. Serum S100 protein: a potential marker for cerebral events during cardiopulmonary bypass. Ann Thorac Surg. 1996; 61 (1): 88–92. DOI: https://doi.org/10.1016/0003-4975(95)00904-3   

14.                   Hatton G.I. Glial-neuronal interactions in the mammalian brain. Adv Physiol Educ. 2002; 26: 225–37. DOI: https://doi.org/10.1152/advan.00038.2002   

15.                   Yuan S.M. S100 and S100β: biomarkers of cerebral damage in cardiac surgery with or without the use of cardiopulmonary bypass. Rev Bras Cir Cardiovasc. 2014; 29 (4): 630–41. DOI: https://doi.org/10.5935/1678-9741.20140084

16.                   Listewnik M., Kotfis K., Ślozowski P., Mokrzycki K., Brykczyński M. The influence of carbon dioxide field flooding in mitral valve operations with cardiopulmonary bypass on S100ß level in blood plasma in the aging brain. Clin Interv Aging. 2018; 13: 1837–45. DOI: https://doi.org/10.2147/CIA.S177356

17.                   Rapp J.H., et al. Atheroemboli to the brain: size threshold for causing acute neuronal cell death. J Vasc Surg. 2000; 32 (1): 68–76. DOI: https://doi.org/10.1067/mva.2000.107315

18.                   Borger M.A., Peniston C.M., Weisel R.D., Vasiliou M., Green R.E., Feindel C.M. Neuropsychologic impairment after coronary bypass surgery: effect of gaseous microemboli during perfusionist interventions. J Thorac Cardiovasc Surg. 2001; 121: 743–9. DOI: https://doi.org/10.1067/mtc.2001.112526-11

19.                   Sandrikov V.A., Sadovnikov V.I., Fedulova S.V., Aliev S.M. Monitoring of microembolic signals in cerebral vessels in the early postoperative period in patients undergoing cardiac surgery. Ultrasound and Functional Diagnostics. 2010; (5): 54–62. (in Russian)

20.                   Lokshin L.S. Gas microembolism with cardiopulmonary bypass. Anesthesiology and Reanimatology. 2015; 60 (5): 17–20. (in Russian)

21.                   Medvedeva L.A., Zagorulko O.I., et al. Cognitive postoperative dysfunction in cardiac surgery. Cardiology and Cardiovascular Surgery. 2012; (4): 46–54. (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)

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