CC BY-NC-ND 4.0 · Thorac Cardiovasc Surg 2019; 67(S 04): e11-e18
DOI: 10.1055/s-0039-3401793
Pediatric and Congenital Cardiology
Georg Thieme Verlag KG Stuttgart · New York

Glial Fibrillary Acid Protein and Cerebral Oxygenation in Neonates Undergoing Cardiac Surgery

1  Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein—Campus Kiel, Kiel, Germany
2  DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany
,
Lydia Kissner
1  Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein—Campus Kiel, Kiel, Germany
,
Guranda Chitadze
3  Institute of Immunology, University Hospital Schleswig-Holstein—Campus Kiel, Kiel, Schleswig-Holstein, Germany
,
Jana Logoteta
1  Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein—Campus Kiel, Kiel, Germany
,
Olaf Jung
1  Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein—Campus Kiel, Kiel, Germany
,
Peter Dütschke
4  Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein - Campus Kiel, Kiel, Schleswig-Holstein, Germany
,
Tim Attmann
5  Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein - Campus Kiel, Kiel, Germany
,
Jens Scheewe
5  Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein - Campus Kiel, Kiel, Germany
,
Hans-Heiner Kramer
1  Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein—Campus Kiel, Kiel, Germany
2  DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany
› Author Affiliations
Further Information

Publication History

22 June 2019

01 October 2019

Publication Date:
31 December 2019 (online)

Abstract

Background Neonates undergoing surgery for complex congenital heart disease are at risk of developmental impairment. Hypoxic–ischemic brain injury might be a contributing factor. We aimed to investigate the perioperative release of the astrocyte cytoskeleton component glial fibrillary acid protein and its relation to cerebral oxygenation.

Methods Serum glial fibrillary acid protein levels were measured before and 0, 12, 24, and 48 hours after surgery. Reference values were based on preoperative samples; concentrations above the 95th percentile were defined as elevated. Cerebral oxygenation was derived by near-infrared spectroscopy.

Results Thirty-six neonates undergoing 38 surgeries utilizing cardiopulmonary bypass were enrolled (complete data available for 35 procedures). Glial fibrillary acid protein was elevated after 18 surgeries (arterial switch: 7/12; Norwood: 5/15; others: 6/8; p = 0.144). Age at surgery was higher in cases with elevated serum levels (6 [4–7] vs. 4 [2–5] days, p = 0.009) and intraoperative cerebral oxygen saturation was lower (70 ± 10% vs. 77 ± 7%, p = 0.029). In cases with elevated postoperative glial fibrillary acid protein, preoperative cerebral oxygen saturation was lower for neonates undergoing the arterial switch operation (55 ± 9% vs. 64 ± 4%, p = 0.048) and age at surgery was higher for neonates with a Norwood procedure (7 [6–8] vs. 5 [4–6] days, p = 0.028).

Conclusions Glial fibrillary acid protein was elevated after ∼50% of neonatal cardiac surgeries and was related to cerebral oxygenation and older age at surgery. The potential value as a biomarker for cerebral injury after neonatal cardiac surgery warrants further investigation; in particular, the association with neurodevelopmental outcome needs to be determined.

Financial Support

This research received no specific grant from any funding agency, commercial, or not-for-profit sectors.


Authors Contribution

All listed authors fulfilled authorship criteria including substantial contributions to research design or the acquisition, analysis, or interpretation of data; drafting the article or revising it critically; and approval of the submitted and final versions.