Association of intraoperative circulating-brain injury biomarker and neurodevelopmental outcomes at 1 year among neonates who have undergone cardiac surgery

Graham, Eric M.; Martin, Renée; Atz, Andrew M.; Hamlin-Smith, Kasey; Kavarana, Minoo N.; Bradley, Scott M.; Alsoufi, Bahaaldin; Mahle, William T.

doi:10.1016/j.jtcvs.2019.01.040

Cited by 26 publications

(23 citation statements)

References 23 publications

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“…10,[16][17][18][19][20][21] Brain injury is often due to chronic or intermittent low oxygen levels in the brain, decreased brain blood flow from hypoperfusion and/or cardiac arrest, and/or reperfusion injury related to the medical and surgical therapies they have received. 5,9,[22][23][24][25] In addition, genetic contributors include associated congenital structural abnormalities of the brain as well as genetic factors associated with an increased risk for brain injury. 26,27 Compared to the general population, children with complex congenital heart disease have a higher prevalence of deficits in intelligence, academic achievement, executive functioning, visual-motor integration, working memory, processing speed, attention and impulse control, language skills, social cognition, and fine and gross motor skills and a lower health-related quality of life.…”

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confidence: 99%

The origins and development of the Cardiac Neurodevelopmental Outcome Collaborative: creating innovative clinical, quality improvement, and research opportunities

et al. 2020

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Compared to the general population, individuals with complex congenital heart disease are at increased risk for deficits in cognitive, neurodevelopmental, psychosocial, and physical functioning, resulting in a diminished health-related quality of life. These deficits have been well described over the past 25 years, but significant gaps remain in our understanding of the best practices to improve neurodevelopmental and psychosocial outcomes and health-related quality of life for individuals with paediatric and congenital heart disease. Innovative clinical, quality improvement, and research opportunities with collaboration across multiple disciplines and institutions were needed to address these gaps. The Cardiac Neurodevelopmental Outcome Collaborative was founded in 2016 with a described mission to determine and implement best practices of neurodevelopmental and psychosocial services for individuals and their families with paediatric and congenital heart disease through clinical, quality improvement, and research initiatives. The vision is to be a multi-centre, multi-national, multi-disciplinary group of healthcare professionals committed to working together and partnering with families to optimise neurodevelopmental outcomes for individuals with paediatric and congenital heart disease through clinical, quality, and research initiatives, intending to maximise quality of life for every individual across the lifespan. This manuscript describes the development and organisation of the Cardiac Neurodevelopmental Outcome Collaborative.

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The origins and development of the Cardiac Neurodevelopmental Outcome Collaborative: creating innovative clinical, quality improvement, and research opportunities

et al. 2020

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“…Elevations in glial fibrillary acidic protein were present immediately after decannulation and occurred prior to changes in creatinine in the setting of kidney injury. The elevated glial fibrillary acidic protein levels in our cohort suggest the presence of neurologic injury in the intraoperative period 10,11 with long-term neurodevelopmental consequences. The brain and the kidneys are both vulnerable to injury during cardiopulmonary bypass, and there are several common physiologic pathways to explain why damage to these organ systems might occur simultaneously.…”

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confidence: 71%

“…Glial fibrillary acidic protein is an astrocyte intermediate filament protein that is upregulated in settings of central nervous system injury 7 and has been shown to be predictive of neurologic injury in various clinical settings, including after acute stroke 8 and cardiac arrest. 9 In neonatal cardiac surgery with cardiopulmonary bypass, elevated post-operative glial fibrillary acidic protein was associated with a worse neurodevelopmental outcome at 12 months of age, 11,12 and in paediatric intensive care patients undergoing extracorporeal membrane oxygenation, high serum glial fibrillary acidic protein levels have been associated with acute brain injury and death. 12 Galectin 3 is a β-Galactoside-binding lectin that plays a role in tissue inflammation and fibrosis.…”

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Post-operative acute kidney injury is associated with a biomarker of acute brain injury after paediatric cardiac surgery

et al. 2020

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Introduction:Children with CHD who undergo cardiopulmonary bypass are at an increased risk of acute kidney injury. This study evaluated the association of end-organ specific injury plasma biomarkers for brain: glial fibrillary acidic protein and heart: Galectin 3, soluble suppression of tumorgenicity 2, and N-terminal pro b-type natriuretic peptide with acute kidney injury in children undergoing cardiopulmonary bypass.Materials and Methods:We enrolled consecutive children undergoing cardiac surgery with cardiopulmonary bypass. Blood samples were collected pre-bypass in the operating room and in the immediate post-operative period. Acute kidney injury was defined as a rise of serum creatinine ≥50% from pre-operative baseline within 7 days after surgery.Results:Overall, 162 children (mean age 4.05 years, sd 5.28 years) were enrolled. Post-operative acute kidney injury developed in 55 (34%) children. Post-operative plasma glial fibrillary acidic protein levels were significantly higher in patients with acute kidney injury (median 0.154 (inter-quartile range 0.059–0.31) ng/ml) compared to those without acute kidney injury (median 0.056 (inter-quartile range 0.001–0.125) ng/ml) (p = 0.043). After adjustment for age, weight, and The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery category, each natural log increase in post-operative glial fibrillary acidic protein was significantly associated with a higher risk for subsequent acute kidney injury (adjusted odds ratio glial fibrillary acidic protein 1.25; 95% confidence interval 1.01–1.59). Pre/post-operative levels of galectin 3, soluble suppression of tumorgenicity 2, and N-terminal pro b-type natriuretic peptide did not significantly differ between patients with and without acute kidney injury.Conclusions:Higher plasma glial fibrillary acidic protein levels measured in the immediate post-operative period were independently associated with subsequent acute kidney injury in children after cardiopulmonary bypass. Elevated glial fibrillary acidic protein likely reflects intraoperative brain injury which may occur in the context of acute kidney injury-associated end-organ dysfunction.

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“…[20][21][22][23][24][25] Especially the value of glial fibrillary acid protein as a predictor of developmental outcome after cardiac surgery is relatively unknown. 25,26 This study aimed to determine perioperative glial fibrillary acid protein levels in neonates undergoing cardiac surgery utilizing cardiopulmonary bypass and to evaluate the association between serum levels and cerebral tissue oxygenation. We hypothesized that higher glial fibrillary acid protein levels are related to impaired perioperative cerebral oxygenation.…”

Section: Introductionmentioning

confidence: 99%

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

Hansen

Kissner

Chitadze

et al. 2019

Thorac cardiovasc Surg

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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.

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Association of intraoperative circulating-brain injury biomarker and neurodevelopmental outcomes at 1 year among neonates who have undergone cardiac surgery

Cited by 26 publications

References 23 publications

The origins and development of the Cardiac Neurodevelopmental Outcome Collaborative: creating innovative clinical, quality improvement, and research opportunities

The origins and development of the Cardiac Neurodevelopmental Outcome Collaborative: creating innovative clinical, quality improvement, and research opportunities

Post-operative acute kidney injury is associated with a biomarker of acute brain injury after paediatric cardiac surgery

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

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