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[Clinical study of serum S-100 beta protein as marker of brain injury in cardiovascular surgery].

There is no simple and specific marker of brain injury in cardiovascular surgery. S-100 beta protein is a specific protein of the central nervous system. S-100 beta protein detected in spinal fluid and serum is a reflection of brain injury. The aim of this study was to investigate the influence of extracorporeal circulation (ECC) on the brain, with reference to serum S-100 beta protein level and operative factors. Twenty-two patients (12 undergoing coronary artery bypass grafting (CABG), 2 mitral valve replacement, 2 left ventricular aneurysmectomy, 2 grafting of descending thoracic aneurysm, 1 aortic valve replacement (AVR), 1 CABG with AVR, 1 closure of atrial septal defect, 1 aorto-bifemoral and left subclavian artery bypass grafting) without symptomatic neurological complications underwent cardiovascular surgery using ECC. Serum S-100 beta level was measured by enzyme-linked immunosorbent assay before ECC and half an hour after the end of ECC in cardiovascular surgery. Carotid lesions, calcification of the ascending aorta, history of cerebral infarction, and pulsatile or nonpulsatile flow during ECC were evaluated as the operative factors. The correlation of S-100 beta level after ECC with age, duration of ECC and aortic cross clamp time was examined. Serum S-100 beta level was significantly increased after ECC (0.25 +/- 0.48 microgram/l vs. 0.99 +/- 0.64 microgram/l; p < 0.01). Calcification of the ascending aorta was the only significant operative factor that increased S-100 beta level after ECC (calcification 1.35 +/- 0.71 vs. non-calcification 0.68 +/- 0.37 p < 0.01). S-100 beta level after ECC was related to aortic cross clamp time (r = 0.54; p < 0.05, n = 20). It is suggested that brain injury, as reflected by serum S-100 beta protein, is more frequent in cases with calcification of the ascending aorta or a long aortic cross clamp time. It was concluded that serum S-100 beta is a simple potential marker of cerebral injury in cardiovascular surgery with ECC.