Does Off-pump Coronary Revascularization Reduce the Release of the Cerebral Markers, S-100β and NSE?

ObjectivesThe aims of this study were to (1) compare the release of S-100β and NSE in off-pump coronary artery bypass grafting (CABG) versus on-pump surgery; (2) investigate whether the S-100β and NSE serum concentrations correlate with cardiopulmonary bypass (CPB) duration.Materials and methodsBetween October 2002 and May 2004, 42 patients undergoing first time CABG surgery were enrolled in the study. The exclusion criteria were: LVEF < 35%, age > 70 years, previous myocardial infarction, REDO surgery, the presence of valvular heart disease and/or cerebrovascular disease, abnormal preoperative carotid vessels angiography, coronary artery disease involving the distal circumflex artery, renal dysfunction, coagulopathy. The patients were randomly assigned either to undergo on-pump CABG surgery [group I, n = 24 patients] or off-pump CABG [group II, n = 18 patients]. Blood was not re-transfused from the cardiotomy suction. All patients presenting haemolysis were excluded from the study.ResultsThe preoperative S-100β was 0.13 ± 0.08 (μg/l) and NSE 7 ± 1.5 (μg/l) in group I and 0.12 ± 0.1 (μg/l) and 6.9 ± 2.7 (μg/l), respectively in group II. Six hours after the surgery, S-100β in patients of group I reached a maximum level of 1.38 ± 0.4 (μg/l) and NSE of 17.7 ± 6.5 (μg/l) compared to 0.5 ± 0.11 (μg/l) [S-100B] and NSE 8.6 ± 4.2 (μg/l) in group II (p = 0.001). Three (12%) patients in group I and none (0%) in group II suffered postoperative delirium, p = 0.247. No strokes occurred linear regression analysis revealed a strong correlation between cardiopulmonary bypass duration and S-100β and NSE peak levels, p < 0.0021 (r2 = 0.36) and p < 0.0001 (r = 0.81), respectively.ConclusionCoronary artery bypass surgery with CPB causes a significantly greater increase in NSE and S-100β serum levels than off-pump surgery and correlates with CPB duration.