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Cardiopulmonary-Bypass Glial Fibrillary Acidic Protein Correlates With Neurocognitive Skills.
- Source :
-
The Annals of thoracic surgery [Ann Thorac Surg] 2018 Sep; Vol. 106 (3), pp. 792-798. Date of Electronic Publication: 2018 May 05. - Publication Year :
- 2018
-
Abstract
- Background: Neurocognitive deficits at school starting age may affect as many as 50% of children who underwent cardiac surgery for complex congenital heart disease (CHD). The aim of this study was to identify which phases of cardiopulmonary bypass (CPB) are associated with an increased risk of impaired neurodevelopmental skills in children with complex CHD. This was assessed by means of glial fibrillary acidic protein (GFAP) plasma levels during CPB for CHD surgery, as a marker of neurologic insult. We correlated GFAP levels with clinical parameters and neurodevelopmental outcome.<br />Methods: We studied 45 children undergoing surgery for complex CHD. We measured plasma GFAP levels by enzyme-linked immunosorbent assay at the following steps: anesthesia induction, CPB start, end of hypothermia, end of rewarming, and end of CPB. Neurologic assessment and Vineland Adaptive Behavior Scales (VABS-I) were administered to patients at least 18 months after surgery.<br />Results: GFAP was undetectable before surgery and it peaked at the end of hypothermia or rewarming. Multiple regression analyses showed that GFAP peak level and preoperative neurologic comorbidity were significant independent predictors of neurologic impairment, as showed by VABS-I communication domain intelligence quotient (IQ). Receiver operating characteristic curve showed that the model was highly significant.<br />Conclusions: Impaired neurodevelopment was associated with increase of GFAP plasma levels during cardiac surgery in infants. The identification of the neurologic high-risk phases of CPB run could support the application of new neuroprotective strategies for CHD repair.<br /> (Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Academic Medical Centers
Biomarkers blood
Cardiopulmonary Bypass adverse effects
Child
Cognition Disorders etiology
Cognition Disorders physiopathology
Cohort Studies
Female
Follow-Up Studies
Heart Defects, Congenital diagnostic imaging
Humans
Hypothermia, Induced methods
Incidence
Infant
Infant, Newborn
Intellectual Disability blood
Intellectual Disability etiology
Italy
Male
Multivariate Analysis
Neurologic Examination methods
Prospective Studies
ROC Curve
Regression Analysis
Risk Assessment
Cardiopulmonary Bypass methods
Cognition Disorders epidemiology
Glial Fibrillary Acidic Protein blood
Heart Defects, Congenital surgery
Intellectual Disability epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 1552-6259
- Volume :
- 106
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- The Annals of thoracic surgery
- Publication Type :
- Academic Journal
- Accession number :
- 29733822
- Full Text :
- https://doi.org/10.1016/j.athoracsur.2018.03.083