Changes in S100β protein levels in cerebrospinal fluid after thoracoabdominal aortic operations

AbstractJ Thorac Cardiovasc Surg 2001;122:1019-2

Arterio-jugular Differences in Serum S-100β Proteins in Patients Receiving Selective Cerebral Perfusion

Purpose The early increase in serum S100β after cardiopulmonary bypass (CPB) seems to be derived from an extracerebral source. To exclude contamination, we investigated the arterio-jugular differences in S100β levels in patients receiving selective cerebral perfusion (SCP). We also evaluated the brain-protective effect of SCP by comparing the arterial S100β levels with those in patients undergoing coronary artery bypass grafting (CABG). Methods We measured arterial and jugular venous levels of S100β in ten patients undergoing aortic arch repair with SCP for up to 12h postoperatively (SCP group). We also measured arterial levels of S100β in nine patients undergoing CABG (CPB group). Results There was no incidence of hospital death or stroke. The arterial levels of S100β in both groups were comparable and peaked just after the conclusion of CPB. The arterial and jugular venous levels of S100β were almost equivalent. The arterio-jugular differences in S100β levels were negligible, even in our SCP-group patient with postoperative delirium, who had a peak value three times higher than the other patients. Conclusions The arterio-jugular differences in S100β did not clarify the origin of their increase. Thus, measuring the jugular venous levels of S100β in patients without postoperative clinical neurological deterioration would be of little benefit. However, SCP seems to protect the brain against S100β release as effectively as conventional CPB

Preoperative aortic root geometry and postoperative cusp configuration primarily determine long-term outcome after valve-preserving aortic root repair

ObjectiveTechnical controversies exist in valve-preserving aortic root replacement. We sought to determine predictors of long-term stability of the aortic valve.MethodsA total of 430 patients (aged 57 ± 15 years, 323 male) underwent valve-preserving aortic root surgery (remodeling in 401, reimplantation in 29) between 1995 and 2009 and were followed echocardiographically. Factors influencing late recurrence of aortic valve regurgitation grade II or greater (n = 45) or need for reoperation on the aortic valve (n = 25) were analyzed.ResultsEarly mortality was 2.8% (1.9% for elective cases), and actuarial survival at 10 years was 83.5% ± 2.4%. Ten-year freedom from aortic valve regurgitation grade II or greater was 85.0% ± 2.5%. Preoperative aortoventricular junction diameter greater than 28 mm and postoperative effective height of the aortic cusp less than 9 mm were identified as significant predictors for late aortic valve regurgitation grade II or greater in multivariate analysis (both P < .001). Ten-year freedom from reoperation on the aortic valve was 89.3% ± 2.5%. Preoperative aortoventricular junction diameter greater than 28 mm (P < .001), use of pericardial patch (P = .022), and effective height of the aortic cusp less than 9 mm (P = .049) were identified as significant predictors for reoperation in multivariate analysis. Operative technique (remodeling, reimplantation), Marfan syndrome, bicuspid valve anatomy, concomitant central cusp plication, size of prosthesis used, and acute dissection were not associated with an increased risk of late aortic valve regurgitation grade II or greater or reoperation. In patients with preoperative aortoventricular junction diameter greater than 28 mm (n = 94), the addition of central cusp plication significantly improved freedom from aortic valve regurgitation grade II or greater (P = .006) regardless of root procedures (remodeling, P = .011; reimplantation, P = .053).ConclusionsLong-term stability of valve-preserving aortic root replacement was influenced not by the technique of root repair but by the preoperative aortic root geometry and postoperative cusp configuration

Spontaneous perigraft hematoma suggesting transgraft hemorrhage seven years after thoracic aortic replacement with a Dacron graft

As a previously unrecognized late graft-related complication, we report a case of spontaneous perigraft hemorrhage, which was evidenced by contrast extravasation on computed tomographic scan seven years after thoracic aortic replacement with a knitted Dacron graft. There was no anastomotic problem or graft tear, and the hematoma seemed to result from transgraft hemorrhage. Inadequate graft healing and use of a knitted graft in the thoracic aorta seem underlying. Surgeons should be aware of this complication and we advocate careful long-term follow-up