Jugular Bulb Oxyhemoglobin Desaturation, S100β, and Neurologic and Cognitive Outcomes After Coronary Artery Surgery

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Abstract
We reported that a decline in cognitive performance 3 mo after coronary artery bypass grafting surgery is associated with palpable aortic atheroma, but not postoperative jugular bulb oxyhemoglobin saturation (Sjo2) <50%. However, the effect of Sjo2 on clinical neurologic findings is not known. S100β is a possible surrogate biochemical marker of brain injury, and we report here the scored clinical neurologic findings in 98 patients from our previous study in relation to Sjo2, cognitive performance, aortic atheroma, and S100β. Patients underwent a scored neurologic examination and cognitive assessment the day before and 3 mo after coronary artery bypass grafting surgery. Intraoperatively, intermittent blood sampling was performed, and postoperatively, the area under the curve describing Sjo2 <50% in relation to time was calculated from continuous jugular bulb reflectance oximetry. Palpation was used to assess the ascending aorta for the presence of atheroma. The jugular bulb concentration of S100β was measured 6 h after completion of surgery. The neurologic score 3 mo after surgery did not correlate with either intra- or postoperative Sjo2 (r = 0.111, P = 0.278; and r = −0.074, P = 0.467, respectively). The main determinant of neurologic score at 3 mo was the preoperative neurologic score (r2 = 0.63, P < 0.001), whereas palpable atheroma of the ascending aorta made a small but significant contribution (r2 = 0.034, P = 0.004). Neurologic and cognitive scores correlated before surgery (r = 0.226, P = 0.022) and at 3 mo after surgery (r = 0.348, P < 0.001). A preoperative neurologic deficit of two or more had a small but significant negative effect on cognitive performance at 3 mo (standardized β = −0.097, P = 0.018). There was a significant univariate correlation between S100β and the 3-mo neurologic score (r = −0.232, P < 0.05), but not a multivariate correlation (β = −0.090, P = 0.156).