Section 1: The brain injury of cardiac surgery 1.1 Cerebral physiology and metabolism 1.2 The molecular and biochemical basis of brain injury and heart surgery - Interventions for the future 1.3 The cardiopulmonary bypass circuit and the brain 1.4 The neurological sequelae of cardiac surgery 1.5 The incidence, pre-operative risk factors and long-term outcome of subtle brain injury and cardiac surgery 1.6 The neuropathology of brain injury in cardiac surgery 1.7 Inflammatory response and the brain 1.8 The impact of brain injury on post-surgical quality of life Section 2: The assessment of brain injury 2.1 The utility of neuropsychometric analysis following cardiac surgery 2.2 Pitfalls of neuropsychometric assessment and alternative investigative approaches 2.3 Imaging of the brain in cardiac surgery as a tool in brain protection studies 2.4 Current techniques of emboli detection and their utility in brain protection studies 2.5 Intra-operative brain monitoring in cardiac surgery 2.6 The design of brain protection studies in the 21st century Section 3: Reducing brain injury in cardiac surgery 3.1 Temperature and brain protection in cardiac surgery 3.2 Studies of non-pharmacological interventions to reduce brain injury 3.3 Pharmacological studies to reduce brain injury following cardiac surgery 3.4 Off-pump and on-pump coronary artery surgery and the brain 3.5 Experimental basis and clinical studies of brain protection in paediatric heart surgery 3.6 Experimental basis and clinical studies of brain protection in aortic arch surgery Section 4: The future 4.1 The future of brain protection in cardiac surgery

Brain protection in cardiac surgery

The identification of early noninvasive biochemical markers of disease is a crucial issue of the current scientific research, particularly during the first period of life, since it could provide useful and precocious diagnostic information when clinical and radiological signs are still silent. The ideal biomarker should be practical and sensitive in the precocious identification of at risk patients. An earlier diagnosis may lead to a larger therapeutic window and improve neonatal outcome. Brain damage and sepsis are common causes of severe morbidity with poor outcome and mortality during the perinatal period. A large number of potential biomarkers, including neuroproteins, calcium binding proteins, enzymes, oxidative stress markers, vasoactive agents, and inflammatory mediators, have been so far investigated. The aim of the present review was to provide a brief overview of some of the more commonly investigated biomarkers used in case of neonatal brain damage and sepsis.

/pdf/use-of-early-biomarkers-in-neonatal-brain-damage-and-sepsis-397ayxa77n.pdf

Use of early biomarkers in neonatal brain damage and sepsis: state of the art and future perspectives.

Advances in surgical techniques and perioperative management have led to dramatic improvements in outcomes for children with complex congenital heart disease (CHD). As the number of survivors continues to grow, clinicians are becoming increasingly aware that adverse neurodevelopmental outcomes after surgical repair of CHD represent a significant cause of morbidity, with widespread neuropsychologic deficits in as many as 50% of these children by the time they reach school age. Modifications of intraoperative management have yet to measurably impact long-term neurologic outcomes. However, exciting advances in our understanding of the underlying mechanisms of cellular injury and of the events that mediate endogenous cellular protection have provided a variety of new potential targets for the assessment, prevention, and treatment of neurologic injury in patients with CHD. In this review, we will discuss the unique challenges to developing neuroprotective strategies in children with CHD and consider how multisystem approaches to neuroprotection, such as ischemic preconditioning, will be the focus of ongoing efforts to develop new diagnostic tools and therapies. Although significant challenges remain, tremendous opportunity exists for the development of diagnostic and therapeutic interventions that can serve to limit neurologic injury and ultimately improve outcomes for infants and children with CHD.

/pdf/new-approaches-to-neuroprotection-in-infant-heart-surgery-r3iy4xnh0x.pdf

New approaches to neuroprotection in infant heart surgery

Activin-A is a protein over-expressed and secreted by the brain after neuronal destruction. We evaluated whether serum activin-A increases in asphyxiated full-term newborns (AFTNs) at risk of hypoxic-ischemic-encephalopathy (HIE). 105 consecutive infants (35 affected by perinatal asphyxia due to acute fetal distress; 70 healthy gestational-age matched newborns) underwent cranial assessment and neurologic examination at 12, 24 and 72 hours after birth and, on discharge from the hospital and; activin-A and monitoring laboratory variables assessment at birth. According to the occurrence of HIE within 7-days after birth, AFTNs were subdivided in Group A (n= 20; no/mild HIE with good prognosis) and Group B (n= 15; moderate/severe HIE with a greater risk of neurological handicap). Activin-A was significantly (P less than 0.0001) higher in Groups A and B than controls and highest (P less than 0.001) in Group B. At 0.66 ng/L activin-A achieved a sensitivity of 93.33 per cent and a specificity of 96.63 per cent, respectively, as HIE diagnostic test. These findings show that activin A increased in AFTNs with HIE before the appearance of related signs.

Activin A in asphyxiated full-term newborns with hypoxic ischemic encephalopathy.

Objective: There is growing evidence on the usefulness of biomarkers in the early detection of preterm infants at risk for brain damage. However, among different tools Activin A, S100B protein and adrenomedullin assessment offer the possibility to investigate brain/multiorgan function and development. This could be especially useful in perinatal medicine that requires even more non-invasive techniques in order to fulfill the minimal handling in diagnostic and therapeutic strategy performance. Materials and methods: The concept of Unconventional Biological Fluid (UBF: urine and saliva) is becoming even stronger and regards the assessment in non-invasive biological fluids of biochemical markers involved in the cascade of events leading to brain damage. Results: Activin A, S100B protein and adrenomedullin in UBF were increased in preterm newborns developing brain damage and/or ominous outcome. Conclusions: The present manuscript offers an update on the usefulness of Activin A, S100B protein an adrenomedullin...

Biomarkers of brain damage in preterm infants.

Marker of Neurologic Abnormalities in Children after Open Heart Surgery, Pasquale Florio, Raul Felipe Abella, Teresa de la Torre, Alessandro Giamberti, Stefano Luisi, Gianfranco Bufera, Alessandro Cazzaniga, Alessandro Frigiola, Felice Petraglia, and Diego Gazzolo ( Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy; 2 Department of Cardiac Surgery S. Donato Milanese University Hospital, San Donato Milanese, Italy; 3 Department of Pediatrics and Neuroscience, G. Gaslini Children’s Hospital, Genoa, Italy; 4 Department of Maternal Fetal and Neonatal Health G. Garibaldi Hospital, Catania, Italy; * Address correspondence to this author at: Department of Maternal Fetal and Neonatal Health, G. Garibaldi Hospital, Via Palermo 636, I-95100 Catania, Italy, Fax 39-95-7595208, e-mail dgazzolo@hotmail.com)

Perioperative Activin A Concentrations as a Predictive Marker of Neurologic Abnormalities in Children after

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Perioperative Activin A Concentrations as a Predictive Marker of Neurologic Abnormalities in Children after