Cardiology in the Young

Original Articles

Glial fibrillary acidic protein in children with congenital heart disease undergoing cardiopulmonary bypass

Marissa A. Brunettia1 c1, Jacky M. Jenningsa2, R. Blaine Easleya3, Melania Bembeaa1, Anna Browna1, Eugenie Heitmillera1, Jamie M. Schwartza1, Ken M. Bradya3, Luca A. Vricellaa4 and Allen D. Everetta5

a1 Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America

a2 Departments of Pediatrics and Biostatistics, Johns Hopkins School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America

a3 Department of Anesthesiology and Critical Care Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, United States of America

a4 Department of Cardiac Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America

a5 Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America

Abstract

Objective: To determine whether blood levels of the brain-specific biomarker glial fibrillary acidic protein rise during cardiopulmonary bypass for repair of congenital heart disease. Methods: This is a prospective observational pilot study to characterise the blood levels of glial fibrillary acidic protein during bypass. Children <21 years of age undergoing bypass for congenital heart disease at Johns Hopkins Hospital and Texas Children's Hospital were enrolled. Blood samples were collected during four phases: pre-bypass, cooling, re-warming, and post-bypass. Results: A total of 85 patients were enrolled between October, 2010 and May, 2011. The median age was 0.73 years (range 0.01–17). The median weight was 7.14 kilograms (range 2.2–86.5). Single ventricle anatomy was present in 18 patients (22%). Median glial fibrillary acidic protein values by phase were: pre-bypass: 0 ng/ml (range 0–0.35); cooling: 0.039 (0–0.68); re-warming: 0.165 (0–2.29); and post-bypass: 0.112 (0–0.97). There were significant elevations from pre-bypass to all subsequent stages, with the greatest increase during re-warming (p = 0.0001). Maximal levels were significantly related to younger age (p = 0.03), bypass time (p = 0.03), cross-clamp time (p = 0.047), and temperature nadir (0.04). Peak levels did not vary significantly in those with single ventricle anatomy versus two ventricle repairs. Conclusion: There are significant increases in glial fibrillary acidic protein levels in children undergoing cardiopulmonary bypass for repair of congenital heart disease. The highest values were seen during the re-warming phase. Elevations are significantly associated with younger age, bypass and cross-clamp times, and temperature nadir. Owing to the fact that glial fibrillary acidic protein is the most brain-specific biomarker identified to date, it may act as a rapid diagnostic marker of brain injury during cardiac surgery.

(Received January 08 2013)

(Accepted May 28 2013)

(Online publication July 11 2013)

Keywords

  • Brain biomarker;
  • glial fibrillary acidic protein;
  • cardiopulmonary bypass

Correspondence

c1 Correspondence to: M. A. Brunetti, MD, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 34th and Civic Center Blvd. 7 South Tower 7C26, Philadelphia, PA 19104, United States of America. Tel: +215-590-2365; Fax: +215-590-4620; E-mail: brunettim@email.chop.edu

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