Serum Neuron-Specific Enolase Level as Predictor of Neurologic Outcome after Aortic Surgery.

BACKGROUND: This study aimed to evaluate the significance of serum neuron-specific enolase (NSE) level as a predictor of neurologic injury in thoracic aortic surgery.

METHODS: We neurologically assessed 60 consecutive patients who underwent thoracic aortic surgery for thoracic aortic aneurysm ( n  = 26) and aortic dissection ( n  = 34). Using moderate hypothermic circulatory arrest with antegrade cerebral perfusion, total arch replacement and hemiarch replacement were performed in 37 and 23 patients, respectively. Serum NSE levels in venous blood samples drawn before surgery and at 1 day after surgery were measured. Severity of neurologic injury was categorized as either uncomplicated ( n  = 48), temporary neurologic dysfunction (TND, n  = 5), or permanent neurologic dysfunction (PND, n  = 7). The extent of stroke was estimated on computed tomography or magnetic resonance imaging.

RESULTS: The NSE level significantly differed among the three groups (PND > TND > uncomplicated) on the first postoperative day. Receiver-operating characteristic curve analysis showed that the cutoff value of NSE level was 34.14 ng/mL for neurologic injury (sensitivity, 0.769; specificity, 0.851) and 43.56 ng/mL for PND (sensitivity, 1.000; specificity, 0.963). The NSE level significantly correlated with the extent of stroke ( r  = 0.61, p  < 0.001).

CONCLUSION: Serum NSE level is a significant predictor of adverse neurologic outcomes and extent of stroke after thoracic aortic surgery.