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European Journal of Cardio-Thoracic Surgery, Vol 11, 645-649, Copyright © 1997 by European Association for Cardio-thoracic Surgery
DP Taggart, K Bhattacharya, N Meston, SJ Standing, JD Kay, R Pillai, P Johnssson and S Westaby
INTRODUCTION: Embolization of gaseous and particulate matter is
incriminated in the neuropsychological morbidity of CPB and can be reduced
by membrane oxygenators and arterial line filtration. It is not known if
the use of arterial line filtration in conjunction with membrane
oxygenators might have an additive effect in reducing cerebral injury.
METHODS: Forty patients undergoing elective coronary artery surgery were
prospectively randomized to a 43 microns heparin coated arterial line
filter (Cobe Sentry) or to no filtration (control group). All operations
were performed by one surgeon (DPT) using intermittent ischaemia with
nonpulsatile CPB, a COBE CML membrane oxygenator and alpha-stat paCO2
management. Flow rates were maintained between 2.0 and 2.4 l-1 m2 per min
with a perfusion pressure of 50-80 mmHg and a systemic temperature of 34
degrees C. Cerebral injury was defined by careful neurological examination
and serial measurement of the serum concentration of S-100 protein (a
highly specific astroglial cell derivative, elevated serum levels of which
correlate with proven cerebral injury). RESULTS: There was no difference
[mean (S.D.)] in the control and filter groups with respect to age [61(9)
vs. 62(9) years], ejection fraction, number of grafts [2.8(0.6) vs.
2.6(0.7)] or CPB times [55(19) vs. 57(18) min]. Preoperatively, no patient
had detectable S-100. In the postoperative period 23 of 40 patients (58%)
showed elevated S-100 levels. At 1, 5 and 24 h the respective number of
patients in the control and filter groups with elevated S-100 was (14 vs.
9), (4 vs. 0), (4 vs. 0)) (P < 0.05). No patient had overt cerebral
injury. CONCLUSIONS: This study suggests that (i) subclinical cerebral
injury is common (58% of patients in this study) even after apparently
uncomplicated surgery with short CPB times; (ii) serum S-100 protein is a
valuable marker for investigating potentially cerebral protective
innovations during CPB; and (iii) arterial line filtration significantly
reduces but does not eliminate cerebral injury.
ARTICLES
Serum S-100 protein concentration after cardiac surgery: a randomized trial of arterial line filtration
Oxford Heart Centre, John Radcliffe Hospital, UK.
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 M. S. Ali, M. Harmer, and R. Vaughan Serum S100 protein as a marker of cerebral damage during cardiac surgery Br. J. Anaesth., August 1, 2000; 85(2): 287 - 298. [Abstract] [Full Text] [PDF]
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S. Ashraf, K. Bhattacharya, Y. Tian, and K. Watterson Cytokine and S100B levels in paediatric patients undergoing corrective cardiac surgery with or without total circulatory arrest Eur. J. Cardiothorac. Surg., July 1, 1999; 16(1): 32 - 37. [Abstract] [Full Text] [PDF]
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