Cardiac Surgery is Associated with Biomarker Evidence of Neuronal Damage

Article type: Research Article

Authors: Alifier, Marek^a | Olsson, Bob^{b; c; *} | Andreasson, Ulf^c | Cullen, Nicholas C.^{b; d} | Czyżewska, Jolanta^e | Jakubów, Piotr^f | Sieśkiewicz, Andrzej^g | Stasiak-Barmuta, Anna^a | Hirnle, Tomasz^f | Kornhuber, Johannes^h | Zetterberg, Henrik^{b; c; i; j} | Lewczuk, Piotr^{h; k} | Blennow, Kaj^{b; c}

Affiliations: [a] Department of Clinical Immunology, Medical University of Bialystok Clinical Hospital, Bialystok, Poland | [b] Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden | [c] Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden | [d] Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA | [e] Department of Clinical Laboratory Diagnostics, Medical University of Bialystok Clinical Hospital, Bialystok, Poland | [f] Department of Cardiosurgery, Medical University of Bialystok Clinical Hospital, Bialystok, Poland | [g] Department of Otolaryngology, Medical University of Bialystok Clinical Hospital, Bialystok, Poland | [h] Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen, and Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany | [i] Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK | [j] UK Dementia Research Institute at UCL, London, UK | [k] Department of Neurodegeneration Diagnostics, Medical University of Bialystok Clinical Hospital, Bialystok, Poland

Correspondence: [*] Correspondence to: Bob Olsson, Department of Psychiatry and Neurochemistry, University of Gothenburg, V-house, Sahlgrenska University Hospital Mölndal, 431 80 Mölndal, Sweden. Tel.: +46 31 343 24 00; Fax: +46 31 343 24 26; E-mail: [email protected].

Abstract: Background:Anesthesia and surgery is commonly associated with central nervous system sequelae and cognitive symptoms, which may be caused by neuronal injury. Neuronal injury can be monitored by plasma concentrations of the neuronal biomarkers tau and neurofilament light protein (NFL). Currently, there are no studies examining whether neuronal injury varies between surgical procedures. Objective:Our aim was to investigate if neuronal damage is more frequent after cardiac than after otolaryngeal surgery, as estimated by tau and NFL concentrations in plasma. Methods:Blood samples were drawn before, during, and after surgery and concentrations of tau, NFL, Aβ40, and Aβ42 were measured in 25 patients undergoing cardiac surgery (9 off-pump and 16 on-pump) and 26 patients undergoing otolaryngeal surgery. Results:Tau increased during surgery (1752%, p = 0.0001) and NFL rose seven days post-surgery (1090%, p < 0.0001) in patients undergoing cardiac surgery; even more in patients on-pump than off-pump. No changes were observed in patients undergoing otolaryngeal surgery and only minor fluctuations were observed for Aβ40 and Aβ42. Conclusion:Cardiac surgery is associated with neuronal injury, which is aggravated by extracorporeal circulation. Analyses of NFL and tau in blood may guide development of surgical procedures to minimize neuronal damage, and may also be used in longitudinal clinical studies to assess the relationship of surgery with future neurocognitive impairment or dementia.

Keywords: Cardiac surgery, cognitive impairment, dementia, extracorporeal circulation, neurofilament light protein, plasma, tau

DOI: 10.3233/JAD-191165

Journal: Journal of Alzheimer's Disease, vol. 74, no. 4, pp. 1211-1220, 2020