S100B in cardiac surgery brain monitoring: friend or foe?

Abstract

Recent advances in perioperative management of adult and pediatric patients requiring open heart surgery (OHS) and cardiopulmonary bypass (CPB) for cardiac and/or congenital heart diseases repair allowed a significant reduction in the mortality rate. Conversely morbidity rate pattern has a flat trend. Perioperative period is crucial since OHS and CPB are widely accepted as a deliberate hypoxic-ischemic reperfusion damage representing the cost to pay at a time when standard of care monitoring procedures can be silent or unavailable. In this respect, the measurement of neuro-biomarkers (NB), able to detect at early stage perioperative brain damage could be especially useful. In the last decade, among a series of NB, S100B protein has been investigated. After the first promising results, supporting the usefulness of the protein as predictor of short/long term adverse neurological outcome, the protein has been progressively abandoned due to a series of limitations. In the present review we offer an up-dated overview of the main S100B pros and cons in the peri-operative monitoring of adult and pediatric patients.

S100B predicts neurological injury and 30-day mortality following surgery for acute type A aortic dissection: an observational cohort study

“…This phenomenon is exaggerated by the use of cardiotomy suction and autotransfusion (22). Given the relatively short half-life of S100B, it has been suggested that measurements 24-48 hours after surgery would be less in uenced by contamination from the surgical site (22). Therefore, we believe that the results at T1 were driven by contamination rather than cerebral injury.…”

“…S100B has a short half-life of about 30-60 min and is mainly eliminated by the kidneys (22). The physiological role of S100B is not yet fully understood but depending on its concentration, it can act as a neurotrophic or a neurotoxic factor with high tissue concentrations driving the latter (22). Until recent years, S100B has been believed to passively leak from damaged cells and enter the circulation due to the compromised integrity of the blood brain barrier.…”

“…S100B is a calcium-binding protein primarily found in the glial and Schwann cells of the central nervous system. S100B is not speci c to the central nervous system and also can be found in various other tissues including muscles, adipocytes, the heart, and the liver (22). S100B has a short half-life of about 30-60 min and is mainly eliminated by the kidneys (22).…”

“…S100B is not speci c to the central nervous system and also can be found in various other tissues including muscles, adipocytes, the heart, and the liver (22). S100B has a short half-life of about 30-60 min and is mainly eliminated by the kidneys (22). The physiological role of S100B is not yet fully understood but depending on its concentration, it can act as a neurotrophic or a neurotoxic factor with high tissue concentrations driving the latter (22).…”

“…Previous studies have shown, however, that a signi cant portion of S100B measured in the blood after heart surgery might be of extracerebral origin, presumably from mediastinal fat and other mediastinal tissues (25). This phenomenon is exaggerated by the use of cardiotomy suction and autotransfusion (22). Given the relatively short half-life of S100B, it has been suggested that measurements 24-48 hours after surgery would be less in uenced by contamination from the surgical site (22).…”