Cardiac troponin I after cardiopulmonary bypass in infants in comparison with older children

Gupta-Malhotra, Monesha; Kern, Jeffrey H.; Flynn, Patrick; Schiller, Myles S.; Quaegebeur, Jan M.; Friedman, Deborah

doi:10.1017/s1047951112001163

Cited by 18 publications

(17 citation statements)

References 20 publications

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“…There have been conflicting reports of whether peak TN-I levels are associated with poor surgical outcomes. 9,18,19 Our study did not reveal significant correlation between peak TN-I level and outcomes. In addition, individual TN-I levels varied widely at each time point even within the individual surgical groups, such that no particular TN-I level could be reliably used to predict poor clinical outcome.…”

Section: Discussioncontrasting

confidence: 72%

“…16,17 Previous studies have indicated that infants tend to have higher troponin leak following myocardial damage when compared with older children, and for this reason we narrowed the scope of our cohort to infants younger than 1 year of age. 18 The two major intraoperative factors that correlated with increased postoperative TN-I levels were: (1) the use and duration of CPB, and (2) the requirement of ventricular incision during surgery ( Figure 2). Under ideal circumstances, one would like to establish expected range of post-operative, time-varying troponin levels for every specific procedure.…”

Section: Discussionmentioning

confidence: 99%

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Postoperative Serum Troponin Trends in Infants Undergoing Cardiac Surgery

Kumar

Mahmoud

et al. 2019

Seminars in Thoracic and Cardiovascular Surgery

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Troponin-I (TN-I) levels are elevated following pediatric cardiac surgery with speculation that particular patterns may have prognostic significance. There is lack of procedure-specific data regarding postoperative TN-I levels in infants undergoing cardiac surgery. We hypothesized that TN-I elevation varies with type of surgery and persistent elevation predicts poor prognosis. We prospectively measured serial TN-I levels (preoperatively, 4, 8, 12, 24, and 48hours postoperatively) in 90 infants (age < 1 year) undergoing cardiac surgery: off cardiopulmonary bypass (CPB) (n = 15), on CPB (n = 43), and on CPB with ventricular incision (CPB with ventricular incision; n = 32). All patients had undetectable baseline TN-I levels. The area under the curve of TN-I levels over the 48-hour period was significantly different among the surgical groups (P < 0.002), and highest in patients with CPB with ventricular incision. Generally, TN-I levels peaked by 4hours after surgery and returned to near-normal levels within 48hours. A persistent TN-I rise beyond 8hours after surgery was a strong predictor of postoperative hypoperfusion injury (defined as a composite endpoint of end-organ injury resulting from inadequate perfusion, odds ratio 21.5; P = 0.001) and mortality (30% in those with persistently high TN-I, compared with 3.5% in the remaining patients; P < 0.001), independent of patient age, anatomy and/or complexity of surgery, and level of postoperative support. Our data provide benchmark values for TN-I levels following cardiac surgery in infants. Extent of TN-I elevation correlates with type of surgery. Persistent TN-I elevation beyond 8hours after surgery is strongly associated with postoperative hypoperfusion injury and mortality.

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Section: Discussioncontrasting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Postoperative Serum Troponin Trends in Infants Undergoing Cardiac Surgery

Kumar

Mahmoud

et al. 2019

Seminars in Thoracic and Cardiovascular Surgery

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“…However, recently studies pointed out that high troponin levels were not associated with high cardiovascular risk or mortality in infants who underwent congenital cardiac surgery (16,17) .…”

Section: Discussionmentioning

confidence: 98%

Relation of Troponin I Levels with Postoperative Mortality and Morbidity Rates in Patients Followed in Intensive Care Unit After Congenital Cardiac Surgery Whose Ages Between 7 Days and 16 Years Old

Ak¹,

Yıldız²,

Yurtseven³

et al. 2018

Kosuyolu Heart Journal

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Introduction: Troponin I levels are the most important predictive marker of myocardial injury. Myocardial injury has been reported as the most significant cause of morbidity and mortality in pediatric cardiac surgery. In this study, we aimed to evaluate the effect of troponin I on postoperative mortality and morbidity in the child population. Patients and Methods:Ninety-nine patients to whom congenital cardiac surgery were included in this study. Perioperative and postoperative troponin I values at 24 th and 48 th hours were recorded. Patients were divided into two groups according to troponin I values at 24 th hour (lower and higher than 15 ng/mL, respectively). Aortic cross-clamp time, cardiopulmonary bypass (CPB) time, intubation time, and the duration of intensive care unit stay and medication of inotropic agents were recorded.Results: Postoperative troponin I levels at 24 th hour were higher than 15 ng/mL in patients who underwent congenital cardiac surgery and were related with significantly higher CPB, aortic cross-clamp, intubation time, and longer stay in intensive care unit. Conclusion:Higher troponin I levels at 24 th hour are associated with increased morbidity in patients who undergo congenital cardiac surgery. Hastalar ve Yöntem:Konjenital kardiyak cerrahi uygulanan 99 hastanın perioperatif, postoperatif 24. ve 48. saatteki troponin I değerleri kaydedildi. Hastalar hesaplanan cut off değerine göre 24. saat troponin I seviyelerine göre iki gruba ayrıldı (15 ng/mL'den yüksek olanlar ve olmayanlar). Hastaların aortik kros klemp süreleri, kardiyopulmoner baypas süresi, entübasyon süresi, yoğun bakımda kalış süresi ve inotropik ajan düzeyleri kaydedildi. Bulgular: Konjenital kalp ameliyatı olan hastalarda postoperatif 24. saatte ölçülen troponin I seviyelerinin 15 ng/mL'nin üzerinde olmasının: kardiyopulmoner baypas süresi, aortik kross klamp süresi, entübasyon süresi ve yoğun bakım kalış süresini anlamlı olarak arttırdığı gösterildi.Sonuç: Konjenital kalp ameliyatı olan hastalarda postoperatif 24. saat yüksek troponin I düzeyleri yüksek morbidite riski ile uyumludur.

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“…[12,13] Correlation between the levels of plasma troponin I higher than 100 µg/L after CPB in children and postoperative mortality has been put forward. [12][13][14] In pediatric cardiac surgery, surgical interventions may require ventricular incision and myocardial resection, which increases postoperative CK-MB and troponin I levels. Therefore, obtaining samples for myocardial damage indicators during similar operations is important to provide homogeneity.…”

Section: Discussionmentioning

confidence: 99%

The effect of esmolol on myocardial protection in patients with tetrology of Fallot

Güzelmeriç¹

2016

Turk Gogus Kalp Dama

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Bu çalışmada, Fallot tetralojisi nedeniyle ameliyat edilen çocuklarda ameliyat sırası esmolol infüzyonunun miyokardın korunması üzerine olan etkileri araştırıldı. Ça lış ma pla nı: Ocak 2014-Kasım 2015 tarihleri arasında Fallot tetralojisi nedeniyle ameliyat edilen 50 çocuk hasta (29 erkek, 21 kız; ort. yaş 12.6±2 ay; dağılım 9-20 ay) çalışmaya dahil edildi. Çocuklar rastgele iki gruba ayrıldı ve gruplardan birine ameliyat sırasında esmolol infüzyonu (çalışma grubu) ve diğer gruba serum fizyolojik infüzyonu (kontrol grubu) başlandı. Esmolol infüzyonuna anestezi indüksiyonu ile başlandı (0.05 mg/kg/dk.) ve ardından kardiyopulmoner baypas sırasında doz yarıya indirildi (0.025 mg/kg). Kreatin kinaz-MB, troponin I ve laktat için kan örnekleri trakeal entübasyondan 10 dk. sonra, kardiyopulmoner baypastan beş dk. önce, kardiyopulmoner baypastan beş dk. sonra, ameliyat sonunda, ameliyat sonrasında dördüncü saatte ve ameliyat sonrası birinci günde alındı. Hemodinamik parametreler kaydedildi. Bul gu lar: Kreatin kinaz-MB, troponin I ve laktat düzeyleri kontrol grubunda, çalışma grubundan anlamlı olarak yüksek bulundu (p<0.05). Gruplar arasında ortalama arter basınçları farklılık göstermedi; ancak, kalp hızı çalışma grubunda kontrol grubundan anlamlı olarak düşük bulundu (p<0.05). Çalışma grubunda inotrop skoru daha düşük bulundu (p<0.05). So nuç: Pediyatrik kalp cerrahisinde ameliyat sırası esmolol kullanımı miyokardı hasardan korumada etkin olabilir. Kardiyopulmoner baypası da kapsayacak şekilde çocuklarda ameliyat sırası esmolol infüzyonu kullanımı güvenlidir ve ameliyat sonrası inotrop skorunu azaltmaktadır.

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Cardiac troponin I after cardiopulmonary bypass in infants in comparison with older children

Cited by 18 publications

References 20 publications

Postoperative Serum Troponin Trends in Infants Undergoing Cardiac Surgery

Postoperative Serum Troponin Trends in Infants Undergoing Cardiac Surgery

Relation of Troponin I Levels with Postoperative Mortality and Morbidity Rates in Patients Followed in Intensive Care Unit After Congenital Cardiac Surgery Whose Ages Between 7 Days and 16 Years Old

The effect of esmolol on myocardial protection in patients with tetrology of Fallot

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