Perioperative prediction of neurological dysfunction following mild hypothermic circulatory arrest in total arch replacement via upper hemisternotomy
XIA Lin
YANG Zhong-lu
LIU Yu
NIU Tian-yu
GE Yu-guang
WANG Lu
JIANG Hui
Abstract：Objective To investigate the early warning effect of neuron-specific enolase(NSE)and S100 calcium-binding protein β(S100β)on the severity of brain injury.Methods Patients who were diagnosed as acute type A aortic dissections from June 2020 to May 2021 in the General Hospital of the Northern Theater Command undergoing total arch replacement by the upper-hemisternotomy approach with moderate/mild hypothermic circulatory arrest were included.There were 73 males and 30 females,aged(51.5±10.6)years,ranging from 32 to 74 years.According to different surgical strategies,the patients were divided into the moderate hypothermic circulatory arrest group and the mild hypothermic circulatory arrest group.Serum NSE and S100β concentrations were determined perioperatively.Diagnostic precision of analysis was further conducted based on the presence or absence of neurological dysfunction.Results No significant differences in pre-surgery conditions or levels of NSE and S100β between groups(P＞0.05).Postoperative neurological dysfunction rates,NSE,and S100β levels 24 hours after surgery were similar across groups(P＞0.05).However,NSE and S100β accurately predicted postoperative neurological dysfunction for mild HCA,with preoperative NSE(area under the curve=0.879,optimal cutoff value=5.6,P＜0.05)and S100β(area under the curve=0.816,optimal cutoff value=2.3,P＜0.05)before cardiopulmonary bypass)arrest showing the highest accuracy.Conclusion The minimally invasive approach showed comparable neurological outcomes in moderate/mild hypothermic circulatory arrest.Preoperative NSE and S100β level prior to CPB arrest serve as potential indicators for perioperative neurological dysfunction in ATAAD patients.
Keywords：Acute type A aortic dissectionNeurological dysfunctionNeuron-specific enolaseS100 calcium-binding protein βUpper hemisternotomyCardiopulmonary bypass
Publication Date：2024-12-28
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 326-330 )