Document Detail


Impact of different surgical strategies on perioperative protein s100β release in elderly patients undergoing coronary artery bypass grafting.
MedLine Citation:
PMID:  23989819     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
OBJECTIVE: This study was designed to compare neurological injury-associated protein S100β release during three different treatment modalities, minimized closed circuit coronary artery bypass grafting (CABG) (MCABG), off-pump CABG (OPCAB), and conventional CABG (CCABG), comprising high-volume prime and cold crystalloid cardioplegia. Our working hypothesis was that fluid restriction as provided by MCABG may decrease neurological injury-associated protein S100β release.
METHODS: In this prospective trial, in a tertiary center, 30 surgical patients (aged >70 years, 25 men and 5 women) undergoing first-time elective CABG were enrolled. The inclusion criteria were three-vessel disease and elective surgery. The exclusion criteria were left ventricular ejection fraction of less than 30%, use of clopidogrel, carotid disease, or needing fewer than three distal anastomoses. Protein S100β concentrations, hematocrit (Ht) levels, and PO2 levels were measured after induction of anesthesia, 10 minutes after reperfusion, upon arrival at the intensive care unit, 3 hours postoperatively at the intensive care unit, and the next morning. Statistics consisted of areas under the curve, peak levels, and correlation and variance tests.
RESULTS: A significant negative correlation was found indicating higher S100β release at lower Ht levels and at lower PO2 levels in all study groups. The lowest S100β variance was measured during MCABG (Wilks Λ P = 0.052). The perioperative Ht was significantly higher in the MCABG group and in the OPCAB group compared with the CCABG group (P = 0.04 vs P < 0.01). At all time points, the S100β protein concentration showed no significant differences between the different surgical techniques. The mean (95% confidence interval) values of S100 area under the curve were the following: CCABG, 2.3 (1.06-3.5); MCABG, 1.44 (0.6-2.21); and OPCAB, 1.87 (1.5-2.19) [independent nonparametric Kruskal-Wallis test (P = 0.13)]. The mean (95% confidence interval) peak S100 values (calculated as the maximum value seen in a patient during the research period) were the following: CCABG, 1.07 (0.4-1.68); MCABG, 0.59 (0.28-0.90); and OPCAB, 0.83 (0.59-1.06) [independent nonparametric Kruskal-Wallis test (P = 0.22)].
CONCLUSIONS: Despite similar perioperative S100β protein release for all techniques studied, higher Ht and PO2 levels correlated with lower S100β release within all study groups. The low S100β variance during the fluid restrictive MCABG technique may be due to more efficient oxygen transport to the brain provided by significantly higher perioperative Ht levels. Further prospective data are required to better understand this complex issue.
Authors:
Wim Jan P van Boven; Aurora Morariu; Sacha P Salzberg; Wim B Gerritsen; Frans G Waanders; Tiny C Korse; Leon P Aarts
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Innovations (Philadelphia, Pa.)     Volume:  8     ISSN:  1559-0879     ISO Abbreviation:  Innovations (Phila)     Publication Date:    2013 May-Jun
Date Detail:
Created Date:  2013-08-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101257528     Medline TA:  Innovations (Phila)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  230-6     Citation Subset:  IM    
Affiliation:
From the *Department of Cardio Thoracic Surgery, and †Department of Anaesthesiology, Leiden University Medical Centre, Leiden, the Netherlands; ‡Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, the Netherlands; §Department of Clinical Chemistry and Haematological Laboratory, Gelre Hospital, Apeldoorn, the Netherlands; ∥Dutch Perfusion Service, the Netherlands; and ¶Department of Clinical Chemistry, Netherlands Cancer Institute, Amsterdam, the Netherlands.
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