Abstract
Background
Univentricular congenital heart defects require open-heart surgery soon after birth,
and are associated with risk of brain injury and poor neurologic outcome.
Methods
This is a prospective, observational study on children undergoing cardiac surgery.
Plasma glial fibrillary acidic protein (GFAP), as an early marker of brain injury,
was measured by ELISA at the end of anaesthesia induction, initiation of cardiopulmonary
bypass (CPB), the end of cooling, the end of rewarming, the end of CPB, and after
protamine administration. We recorded clinical and surgical parameters to assess which
CPB phase and clinical parameters were associated with a GFAP increase.
Results
We studied 13 children less than 50 months of age: 8 underwent Norwood or Damus-Kaye-Stansel
palliation (group 1) and 5 underwent Fontan procedure (group 2). A GFAP increase was
only observed in group 1, with the highest median value at the end of rewarming. No
quantifiable levels of GFAP were measured at pre-bypass and the start of CPB stages
in all patients. End of cooling and CPB-end GFAP, GFAP maximum value, and GFAP area
under the curve all correlated with the CPB time spent at a cerebral regional saturation
< 45% (P = 0.021, 0.028, 0.007, 0.021, respectively).
Conclusions
Children with univentricular heart defects exhibit a CPB plasma-GFAP increase only
after stage 1 palliation. The maximum GFAP increase occurred at the end of rewarming.
Further studies are needed to identify which clinical or surgical parameter(s) could
reflect a GFAP increase during surgery for congenital heart defects, and whether GFAP
levels correlate with the neurologic outcome.
Résumé
Introduction
Les malformations cardiaques congénitales univentriculaires nécessitent une intervention
chirurgicale à cœur ouvert peu après la naissance, et sont associées à un risque de
lésions cérébrales et à un mauvais pronostic neurologique.
Méthodes
Ceci est une étude observationnelle prospective sur les enfants subissant une chirurgie
cardiaque. La protéine acide fibrillaire gliale (PAFG), en tant que marqueur précoce
d'une lésion cérébrale, a été mesurée par ELISA à la fin de l’induction d’une anesthésie,
à l'initiation de la circulation extracorporelle (CEC), à la fin du refroidissement,
à la fin du réchauffement, à la fin de la CEC et après l'administration de protamine.
Nous avons enregistré les paramètres cliniques et chirurgicaux pour évaluer quelle
phase de la CEC et quels paramètres cliniques étaient associés avec une augmentation
de la PAFG.
Résultats
Nous avons étudié le cas de 13 enfants âgés de moins de 50 mois : 8 ont subi une chirurgie
palliative de Norwood ou Damus-Kaye-Stansel (groupe 1) et 5 ont subi une intervention
de Fontan (groupe 2). Une augmentation de la PAFG a été observée uniquement dans le
groupe 1, avec une valeur médiane la plus élevée lors de la fin du réchauffement.
Aucun niveau quantifiable de PAFG n’a été mesuré avant dérivation et au début des
étapes de la CEC pour tous les patients. La PAFG en fin de refroidissement et en fin
de CEC, la valeur maximale de PAFG, et l’aire de PAFG sous la courbe sont toutes en
corrélation avec le temps de CEC passé à une saturation cérébrale régionale <45 %
(P = 0,021, 0,028, 0,007, 0,021, respectivement).
Conclusions
Les enfants atteints de malformations cardiaques univentriculaires présentent une
augmentation de la PAFG plasmatique lors de la CEC seulement après l'étape 1 de la
chirurgie palliative. L'augmentation maximale de la PAFG a eu lieu à la fin du réchauffement.
D'autres études sont nécessaires pour déterminer quel(s) paramètre(s) clinique ou
chirurgical pourrait refléter une augmentation de la PAFG pendant la chirurgie pour
des malformations cardiaques congénitales, et si les niveaux de PAFG corrèlent avec
l'évolution neurologique.
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Article info
Publication history
Published online: June 30, 2015
Accepted:
June 24,
2015
Received:
March 25,
2015
Footnotes
See page 360 for disclosure information.
Identification
Copyright
© 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
