Does off-pump coronary revascularization reduce the release of the cerebral markers, S-100beta and NSE?

The aims of this study were to (1) compare the release of S-100β and NSE in off-pump coronary artery bypass grafting (CABG) versus on-pump surgery; (2) investigate whether the S-100β and NSE serum concentrations correlate with cardiopulmonary bypass (CPB) duration. Materials and methods: Between October 2002 and May 2004, 42 patients undergoing first time CABG surgery were enrolled in the study. The exclusion criteria were: LVEF < 35%, age > 70 years, previous myocardial infarction, REDO surgery, the presence of valvular heart disease and/or cerebrovascular disease, abnormal preoperative carotid vessels angiography, coronary artery disease involving the distal circumflex artery, renal dysfunction, coagulopathy. The patients were randomly assigned either to undergo on-pump CABG surgery [group I, n = 24 patients] or off-pump CABG [group II, n = 18 patients]. Blood was not re-transfused from the cardiotomy suction. All patients presenting haemolysis were excluded from the study. Results: The preoperative S-100β was 0.13 ± 0.08 (μg/l) and NSE 7 ± 1.5 (μg/l) in group I and 0.12 ± 0.1 (μg/l) and 6.9 ± 2.7 (μg/l), respectively in group II. Six hours after the surgery, S-100β in patients of group I reached a maximum level of 1.38 ± 0.4 (μg/l) and NSE of 17.7 ± 6.5 (μg/l) compared to 0.5 ± 0.11 (μg/l) [S-100B] and NSE 8.6 ± 4.2 (μg/l) in group II (p = 0.001). Three (12%) patients in group I and none (0%) in group II suffered postoperative delirium, p = 0.247. No strokes occurred linear regression analysis revealed a strong correlation between cardiopulmonary bypass duration and S-100β and NSE peak levels, p < 0.0021 (r 2 = 0.36) and p < 0.0001 (r = 0.81), respectively. Conclusion: Coronary artery bypass surgery with CPB causes a significantly greater increase in NSE and S-100β serum levels than off-pump surgery and correlates with CPB duration. © 2006 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand.