Circulating S100B and Adiponectin in Children Who Underwent Open Heart Surgery and Cardiopulmonary Bypass

Abstract

Background. S100B protein, previously proposed as a consolidated marker of brain damage in congenital heart disease (CHD) newborns who underwent cardiac surgery and cardiopulmonary bypass (CPB), has been progressively abandoned due to S100B CNS extra-source such as adipose tissue. The present study investigated CHD newborns, if adipose tissue contributes significantly to S100B serum levels. Methods. We conducted a prospective study in 26 CHD infants, without preexisting neurological disorders, who underwent cardiac surgery and CPB in whom blood samples for S100B and adiponectin (ADN) measurement were drawn at five perioperative time-points. Results. S100B showed a significant increase from hospital admission up to 24 h after procedure reaching its maximum peak (P < 0.01) during CPB and at the end of the surgical procedure. Moreover, ADN showed a flat pattern and no significant differences (P > 0.05) have been found all along perioperative monitoring. ADN/S100B ratio pattern was identical to S100B alone with the higher peak at the end of CPB and remained higher up to 24 h from surgery. Conclusions. The present study provides evidence that, in CHD infants, S100B protein is not affected by an extra-source adipose tissue release as suggested by no changes in circulating ADN concentrations.

S100B and its relation to cerebral oxygenation in neonates and infants undergoing surgery for congenital heart disease

“…[30][31][32][33][34] In children undergoing surgery for CHD without CPB, postoperative S100B was not increased as compared to preoperative values, while a significant increase was seen in patients operated with CPB. Highest S100B concentrations were typically seen immediately after cardiopulmonary bypass and concentrations normalized to preoperative by extracerebral sources needs to be considered as a potential confounder, but experimental data also suggest that early astrocyte activation after reperfusion is an important source of S100B release into the blood stream.…”

“…[30][31][32][33] The avoidance of direct postoperative samples to identify patients at risk, may minimize possible contamination from extracerebral sources due to surgical trauma. [30][31][32][33] The avoidance of direct postoperative samples to identify patients at risk, may minimize possible contamination from extracerebral sources due to surgical trauma.…”

“…22,23,[27][28][29] Contamination by extracerebral sources needs to be considered as a potential confounder, but experimental data also suggest that early astrocyte activation after reperfusion is an important source of S100B release into the blood stream. [30][31][32][33][34] In children undergoing surgery for CHD without CPB, postoperative S100B was not increased as compared to preoperative values, while a significant increase was seen in patients operated with CPB. 35 In our cohort there was a correlation between the duration of CPB and S100B levels immediately after surgery in infants, but surprisingly not in the group of neonates.…”

“…The clinical utility of S100B as a brain biomarker has been questioned by evidence of extracerebral sources, including adipose tissue. [30][31][32][33] The avoidance of direct postoperative samples to identify patients at risk, may minimize possible contamination from extracerebral sources due to surgical trauma. Data regarding reliable normal values for healthy children is sparse and the use of different assays limits comparability.…”

Recent innovations in perfusion and cardiopulmonary bypass for neonatal and infant cardiac surgery

“…Measurement is possible in biologic fluids via commercially available assays. It has been shown to increase in patients undergoing CPB (69) and not correlated with extra-source adipose tissue release (70). However, there is a lack of studies describing normal s100β levels in the broader pediatric population.…”