Cardiopulmonary Bypass Increases Plasma Glial Fibrillary Acidic Protein Only in First Stage Palliation of Hypoplastic Left Heart Syndrome.
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.
GPYIPR and PCare Laboratories, Pediatric Research Institute "Città della Speranza", Padova, Italy. Electronic address: l.vedovelli@irpcds.org.
Luca
L
Vedovelli
Pediatric and Congenital Cardiovascular Surgery Unit, Centro V. Gallucci, Padova University Hospital, Padova, Italy.
Massimo
M
Padalino
GPYIPR and PCare Laboratories, Pediatric Research Institute "Città della Speranza", Padova, Italy.
Manuela
M
Simonato
Department of Women's and Children's Health, Padova University Hospital, Padova, Italy.
Sara
S
D'Aronco
Pediatric and Congenital Cardiovascular Surgery Unit, Centro V. Gallucci, Padova University Hospital, Padova, Italy.
Diana
D
Bertini
Pediatric and Congenital Cardiovascular Surgery Unit, Centro V. Gallucci, Padova University Hospital, Padova, Italy.
Giovanni
G
Stellin
Department of Medicine DIMED, Anesthesia and Resuscitation Institute, Padova University Hospital, Padova, Italy.
Carlo
C
Ori
Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy.
Virgilio P
VP
Carnielli
Pediatric Cardiac Anesthesia/Intensive Care Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy.
Paola E
PE
Cogo
D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D002675:Child, Preschool; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D005904:Glial Fibrillary Acidic Protein / Q000097:blood*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000097:blood / Q000401:mortality / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008297:Male; D010166:Palliative Care / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends
D015415:Biomarkers; D005904:Glial Fibrillary Acidic Protein