GLIAL FIBRILLARY ACIDIC PROTEIN PLASMA LEVELS DURING CONGENITAL HEART DISEASE SURGERY AND OVER 24 HOURS POST-SURGERY

Background Background. Neuro-cognitive deficits affect nearly 50% of children with complex congenital heart diseases (CHD). Newly acquired brain injury in CHD children affect 30% postoperatively. Objectives Objective. We determined GFAP levels during surgery and for the first 24h after surgery to find out the pivotal timepoint of brain injury during the perioperative period of CHD surgeries. Methods Methods. We studied 43 children: 9 univentricular physiology (UNIV); 16 septal defects (SD); 5 transpositions of the great arteries (TGA), 4 tetralogies of Fallot (TOF), and 9 surgical controls. GFAP was measured by ELISA during surgeries and intensive care stay. Results Results. In controls, mean GFAP (ng/ml) before, after at least 30 min from anesthesia induction, and after surgery were 0.14 ± 0.05, 0.13 ± 0.05, 0.16 ± 0.07, respectively. In CHD patients all GFAP levels collected during intensive care stay were significantly lower than the maximum GFAP level recorded during cardiopulmonary bypass (CPB): at 6h 0.26 ± 0.16; 12h 0.25 ± 0.16; 24h 0.27 ± 0.17 vs. the maximum GFAP 1.69 ± 1.74 during surgery (p<0.001, Wilcoxon Signed Rank Test). There were no GFAP differences between time points in all children. In 10% of the intensive care samples (4 patients: 1 SD, 1 TOF, 2 UNIV), GFAP reached the supposed cut-off for clinical evidence of brain injury (0.46 ng/ml). Conclusion Conclusions. The highest GFAP values were recorded during the CPB run at the end of rewarming rather than in the early post-operative phase. Neurodevelopmental studies are ongoing to correlate GFAP levels to children outcome.