The influence of carbon dioxide field flooding in mitral valve operations with cardiopulmonary bypass on S100ß level in blood plasma in the aging brain

Mariusz Listewnik, Katarzyna Kotfis, Paweł Ślozowski, Krzysztof Mokrzycki, Mirosław Brykczyński, Mariusz Listewnik, Katarzyna Kotfis, Paweł Ślozowski, Krzysztof Mokrzycki, Mirosław Brykczyński

Abstract

Introduction: The risk of air microembolism during cardiopulmonary bypass (CPB) is high and influences the postoperative outcome, especially in elderly patients. The use of carbon dioxide (CO2) atmosphere during cardiac surgery may reduce the risk of cerebral air microembolism. The aim of our study was to assess the influence of CO2 field flooding on microembolism-induced brain damage assessed by the level of S100ß protein, regarded as a marker of brain damage.

Materials and methods: A group of 100 patients undergoing planned mitral valve operation through median sternotomy using standard CPB was recruited for the study. Echocardiography was performed prior to and after the CPB. CO2 insufflation at 6 L/minute was conducted in the study group. Blood samples for S100ß protein analysis were collected after induction of anesthesia, 2 hours after aorta de-clamping, and 24 hours after operation.

Results: The S100ß level in blood plasma did not differ significantly between the study and the control group (0.13±0.08 µg/L, 1.12±0.59 µg/L, and 0.26±0.23 µg/L and 0.18±0.19 µg/L, 1.31±0.62 µg/L, and 0.23±0.12 µg/L, P=0.7, 0.14, and 0.78). The mean increase of the S100ß concentration was 13% lower in the group with CO2 protection than in the control group (0.988 µg/L vs 1.125 µg/L), although statistically insignificant. Tricuspid valve annuloplasties (TVAs) had significant impact on the increase in S100ß concentration in the treatment group after 24 hours (TVA [-] 0.21±0.09 vs TVA [+] 0.42±0.42, P=0.05). In patients <60 years, there were significant differences in the S100ß level 2 and 24 hours after the procedure (1.59±0.682 µg/L vs 1.223±0.571 µg/L, P=0.048, and 0.363±0.318 µg/L vs 0.229±0.105 µg/L, P=0.036) as compared with younger patients.

Conclusion: The increase in S100ß concentration was lower in the group with CO2 protection than in the control group. Age and an addition of TVA significantly influenced the level of S100ß concentration in the tests performed 2 hours after aortic clamp release.

Keywords: S100ß; air microembolism; carbon dioxide insufflation; cardiopulmonary bypass; mitral valve surgery.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

References

    1. Seco M, Edelman JJ, Wilson MK, Bannon PG, Vallely MP. Serum biomarkers of neurologic injury in cardiac operations. Ann Thorac Surg. 2012;94(3):1026–1033.
    1. Nichols HT, Morse DP, Hirose T. Coronary and other air embolization occurring during open cardiac surgery; prevention by the use of gaseous carbon dioxide. Surgery. 1958;43(2):236–244.
    1. Oka Y, Inoue T, Hong Y, Sisto DA, Strom JA, Frater RW. Retained intracardiac air. Transesophageal echocardiography for definition of incidence and monitoring removal by improved techniques. J Thorac Cardiovasc Surg. 1986;91(3):329–338.
    1. Selnes OA, McKhann GM. Neurocognitive complications after coronary artery bypass surgery. Ann Neurol. 2005;57(5):615–621.
    1. Skidmore KL, Jones C, DeWet C. Flooding the surgical field with carbon dioxide during open heart surgery improves segmental wall motion. J Extra Corpor Technol. 2006;38(2):123–127.
    1. Webb WR, Harrison LH, Jr, Helmcke FR, et al. Carbon dioxide field flooding minimizes residual intracardiac air after open heart operations. Ann Thorac Surg. 1997;64(5):1489–1491.
    1. Selman MW, McAlpine WA, Albregt H, Tatan R. An effective method of replacing air in the chest with CO2 during open-heart surgery. J Thorac Cardiovasc Surg. 1967;53(5):618–622.
    1. O’Connor BR, Kussman BD, Park KW. Severe hypercarbia during cardiopulmonary bypass: a complication of CO2 flooding of the surgical field. Anesth Analg. 1998;86(2):264–266.
    1. Lippmann M. Complications of CO2 flooding the surgical field in open heart surgery: an old technique revisited. Anesth Analg. 1998;87(4):978–979.
    1. Barnard J, Speake D. In open heart surgery is there a role for the use of carbon dioxide field flooding techniques to reduce the level of post-operative gaseous emboli? Interact Cardiovasc Thorac Surg. 2004;3(4):599–602.
    1. Giordano S, Biancari F. Does the use of carbon dioxide field flooding during heart valve surgery prevent postoperative cerebrovascular complications? Interact Cardiovasc Thorac Surg. 2009;9(2):323–326.
    1. Baudet E. Personal Contact. Bordeaoux, France: 1998.
    1. Martens S, Dietrich M, Doss M, Wimmer-Greinecker G, Moritz A. Optimal carbon dioxide application for organ protection in cardiac surgery. J Thorac Cardiovasc Surg. 2002;124(2):387–391.
    1. Svenarud P, Persson M, Van Der Linden J. Efficiency of a gas diffuser and influence of suction in carbon dioxide deairing of a cardiothoracic wound cavity model. J Thorac Cardiovasc Surg. 2003;125(5):1043–1049.
    1. Kalpokas MV, Nixon IK, Kluger R, Beilby DS, Silbert BS. Carbon dioxide field flooding versus mechanical de-airing during open-heart surgery: a prospective randomized controlled trial. Perfusion. 2003;18(5):291–294.
    1. Toner I, Peden CJ, Hamid SK, Newman S, Taylor KM, Smith PL. Magnetic resonance imaging and neuropsychological changes after coronary artery bypass graft surgery: preliminary findings. J Neurosurg Anesthesiol. 1994;6(3):163–169.
    1. Restrepo L, Wityk RJ, Grega MA, et al. Diffusion- and perfusion-weighted magnetic resonance imaging of the brain before and after coronary artery bypass grafting surgery. Stroke. 2002;33(12):2909–2915.
    1. Barber PA, Hach S, Tippett LJ, Ross L, Merry AF, Milsom P. Cerebral ischemic lesions on diffusion-weighted imaging are associated with neurocognitive decline after cardiac surgery. Stroke. 2008;39(5):1427–1433.
    1. Moody DM, Brown WR, Challa VR, Stump DA, Reboussin DM, Legault C. Brain microemboli associated with cardiopulmonary bypass: A histologic and magnetic resonance imaging study. Ann Thorac Surg. 1995;59(5):1304–1307.
    1. Vanninen R, Aikiä M, Könönen M, et al. Subclinical cerebral complications after coronary artery bypass grafting: prospective analysis with magnetic resonance imaging, quantitative electroencephalography, and neuropsychological assessment. Arch Neurol. 1998;55(5):618–627.
    1. Bendszus M, Reents W, Franke D, et al. Brain damage after coronary artery bypass grafting. Arch Neurol. 2002;59(7):1090–1095.
    1. Knipp SC, Matatko N, Wilhelm H, et al. Evaluation of brain injury after coronary artery bypass grafting. A prospective study using neuropsychological assessment and diffusion-weighted magnetic resonance imaging. Eur J Cardiothorac Surg. 2004;25(5):791–800.
    1. Cook DJ, Huston J, 3rd, Trenerry MR, Brown RD, Jr, Zehr KJ, Sundt TM., 3rd Postcardiac surgical cognitive impairment in the aged using diffusion-weighted magnetic resonance imaging. Ann Thorac Surg. 2007;83(4):1389–1395.
    1. Motallebzadeh R, Kanagasabay R, Bland M, Kaski JC, Jahangiri M. S100 protein and its relation to cerebral microemboli in on-pump and off-pump coronary artery bypass surgery. Eur J Cardiothorac Surg. 2004;25(3):409–414.
    1. Bonacchi M, Prifti E, Maiani M, Bartolozzi F, di Eusanio M. Leacche M. Does off-pump coronary revascularization reduce the release of the cerebral markers, S-100beta and NSE? Heart Lung Circ. 2006;15(5):314–319.
    1. Martin KK, Wigginton JB, Babikian VL, Pochay VE, Crittenden MD, Rudolph JL. Intraoperative cerebral high-intensity transient signals and postoperative cognitive function: a systematic review. Am J Surg. 2009;197(1):55–63.
    1. Haggag KJ, Russell D, Walday P, Skiphamn A, Torvik A. Air-filled ultrasound contrast agents do not damage the cerebral microvasculature or brain tissue in rats. Invest Radiol. 1998;33(3):129–135.
    1. Neville MJ, Butterworth J, James RL, Hammon JW, Stump DA. Similar neurobehavioral outcome after valve or coronary artery operations despite differing carotid embolic counts. J Thorac Cardiovasc Surg. 2001;121(1):125–136.
    1. Herrmann M, Ebert AD, Tober D, Hann J, Huth C. A contrastive analysis of release patterns of biochemical markers of brain damage after coronary artery bypass grafting and valve replacement and their association with the neurobehavioral outcome after cardiac surgery. Eur J Cardiothorac Surg. 1999;16(5):513–518.
    1. Martens S, Theisen A, Balzer JO, et al. Improved cerebral protection through replacement of residual intracavital air by carbon dioxide: a porcine model using diffusion-weighted magnetic resonance imaging. J Thorac Cardiovasc Surg. 2004;127(1):51–56.
    1. Herrmann M, Ebert AD, Galazky I, Wunderlich MT, Kunz WS, Huth C. Neurobehavioral outcome prediction after cardiac surgery: role of neurobiochemical markers of damage to neuronal and glial brain tissue. Stroke. 2000;31(3):645–650.
    1. Kilminster S, Treasure T, McMillan T, Holt DW. Neuropsychological change and S-100 protein release in 130 unselected patients undergoing cardiac surgery. Stroke. 1999;30(9):1869–1874.
    1. Ueno T, Iguro Y, Yamamoto H, Sakata R, Kakihana Y, Nakamura K. Serial measurement of serum S-100B protein as a marker of cerebral damage after cardiac surgery. Ann Thorac Surg. 2003;75(6):1892–1897. discussion 1897–1898.
    1. Ramlawi B, Rudolph JL, Mieno S, et al. Serologic markers of brain injury and cognitive function after cardiopulmonary bypass. Ann Surg. 2006;244(4):593–601.
    1. Georgiadis D, Berger A, Kowatschev E, et al. Predictive value of S-100beta and neuron-specific enolase serum levels for adverse neurologic outcome after cardiac surgery. J Thorac Cardiovasc Surg. 2000;119(1):138–147.
    1. Jönsson H, Johnsson P, Alling C, Bäckström M, Bergh C, Blomquist S. S100beta after coronary artery surgery: release pattern, source of contamination, and relation to neuropsychological outcome. Ann Thorac Surg. 1999;68(6):2202–2208.
    1. Chaudhuri K, Storey E, Lee GA, et al. Carbon dioxide insufflation in open-chamber cardiac surgery: a double-blind, randomized clinical trial of neurocognitive effects. J Thorac Cardiovasc Surg. 2012;144(3):646–653.e1.
    1. Sun Y, Ji B, Zhu X, Zheng Z. Efficacy of carbon dioxide insufflation for cerebral and cardiac protection during open heart surgery: a systematic review and meta-analysis. Artif Organs. 2013;37(5):439–446.

Source: PubMed

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