A Clinical Study On Cerebral Injury During Intracardic Procedures On-pump Beating Heart Compared With That On Arrested Heart

Objective The aim of this study was to compare the cerebral injury in on-pump beating-heart intracardiac procedures with that in traditional arrested heart intracardiac procedures. Methods Forty patients, including of twenty patients with congenital heart disease and twenty patients with rheumatic heart valve disease, were randomly divided into two groups: on-pump arrested heart group(Group A, n=20) and on-pump beating-heart group(Group B, n=20). There were ten cases of congenital heart disease and ten cases of rheumatic heart disease in each group. The patients in Group A underwent traditional arrested-heart intracardiac procedures, and the patients in Group B underwent on-pump beating-heart intracardiac procedures. Arterial blood was sampled at preoperation, twenty minutes after the start of CPB, one hour after CPB and twenty-four hours after operation. Levels of plasma neuron specific enolase(NSE) and protein S-100b were measured with ELISA. All the patients' electroencephalograms(EEGs) were examined before and one week after operations. The perioperative plasma NSE ,protein S-100b and EEG changes of the two groups were compared statistically. Results The levels of plasma protein S-100b increased significantly at twenty minutes after the start of CPB, and maintained high level till twenty four hours after operation(p<0.01). The level of plasma NSE in congenital heart disease group increased more significantly than that did in rheumatic heart disease group at twenty minutes after the start of CPB. The level of plasma NSE in congenital heart disease group returned to the nadir at twenty four hours after operation, but it was still higher than the preoperative level in rheumatic heart disease group at the same time(p<0.01). The level of plasma NSE in group A was significantly higher than that in group B at twenty minutes after the start of CPB. The protein S-100b of the patients with congenital heart disease in group A was significantly higher than that in group B at twenty minutes after the start of CPB (p<0.05).There was no significant difference between the twe groups at other times. The postoperative EEG abnormality rates were 65% in group A and 70% in group B respectively. There was no significant difference between two groups. Conclusion Our preliminary results showed that the levels of plasma NSE and S-100bincreased significantly during intracardic procedures both on-pump beating-heart and on traditional arrested heart; postoperative EEG became even worse than that before operation, which implicated that intracardic procedures under CPB might induce some cerebral injury. The increase of NSE and S-100b in the beating-heart group and the abnormality of the postoperative EEG are not more significant than those in the arrested-heart group, which recommend that the cerebral injury induced by on-pump beating heart intracardic procedures was not more severe than that by traditional arrested heart operations.