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J Thorac Cardiovasc Surg 2003;125:S31-S33
© 2003 The American Association for Thoracic Surgery

Editorials

Biochemical markers of neurologic injury in cardiac surgery: The rise and fall of S100ß

Jarle Vaage, MD, PhD, FETCSa, Russell Anderson, MD, PhDb

From the Departments of Thoracic Surgerya and Thoracic Anaesthetics and Intensive Care,b Karolinska Hospital, Stockholm, Sweden.

Received for publication July 3, 2001. Accepted for publication July 13, 2001. Address for reprints: Jarle Vaage, MD, Department of Thoracic Surgery, Karolinska Hospital, S-17176, Stockholm, Sweden (E-mail: jarle.vaage@ks.se).

The first 300 words of the full text of this article appear below.


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  		Dr Vaage

 
With the change in patient population toward older and sicker patients undergoing cardiac surgery, neurologic injury has emerged as perhaps the most important perioperative complication, and its frequency increases exponentially with increasing age.Go 1 Particular attention has been paid to the role of cardiopulmonary bypass per seGo 2 and thromboembolization from the ascending aorta.Go 3 However, neurologic injury is not limited to only stroke and comaGo 1; increasingly there is a focus on the more subtle neurocognitive dysfunction and its consequences on quality of life.Go Go 4,5

The majority of cases of gross neurologic injury do not represent a diagnostic problem, as at the time of diagnosis the injury is usually manifest and irreversible. Neurocognitive dysfunction, however, is less accessible for quantification, which requires time-consuming neuropsychologic testing. With only a few exceptions, such testing has been unavailable for the cardiac surgeon. Prompted by the increasing awareness of neurologic injury, as well as the emergence of minimally invasive cardiac surgery, there is at present an increasing interest in cognitive testing. However, such testing will remain a research method and not available in everyday clinical practice because of the time and manpower it consumes.

A biochemical marker in the blood of the patients—"a troponin of the brain"—would represent a revolution in the investigation and diagnosis of neurologic injury in cardiac surgery. A serum marker could potentially identify which aspect(s) of cardiac surgery are responsible for cognitive dysfunction and evaluate the efficacy of alternative surgical techniques. Additionally, if marker concentrations during or directly after surgery could be related to cognitive dysfunction or shown to predict gross neurologic injury that became clinically evident after some hours (or days), then potentially neuroprotective interventions might be indicated.

The ideal biochemical marker should have the following properties:

  1. Central nervous specificity
  2. Rapid and significant release into blood after injury, preferably within . . . [Full Text of this Article]






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