Cardiac Troponin I Release After Coronary Artery Bypass Grafting Operation: Effects on Operative and Midterm Survival

Paparella, Domenico; Cappabianca, Giangiuseppe; Visicchio, Giuseppe; Galeone, Antonella; Marzovillo, Angelo; Gallo, Nunzio; Memmola, Cataldo; Schinosa, Luigi de Luca Tupputi

doi:10.1016/j.athoracsur.2005.04.040

Cited by 48 publications

(30 citation statements)

References 22 publications

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“…This partially explains the different optimal cTn cut points in various studies in post-CABG testing. 3,17,25,26 The results of studies similar to ours have clearly shown the utility of both cTnI and cTnT for prognostication purposes in the postcardiac surgery setting; however, no large-scale comparative data between cTnI and cTnT are available in this population. Such studies are needed to better understand the similarities and differences of the various cTn methods in this setting.…”

Section: Mohammed Et Al Troponin T After Cardiac Surgery 847mentioning

confidence: 77%

Prospective, Comprehensive Assessment of Cardiac Troponin T Testing After Coronary Artery Bypass Graft Surgery

et al. 2009

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Background-The significance and clinical role of cardiac troponin testing after coronary artery bypass grafting remain unclear. Methods and Results-Cardiac troponin T (cTnT) was measured during the first 24 hours after coronary artery bypass graft surgery in 847 consecutive patients. Only 17 patients (2.0%) had new Q waves or left bundle-branch block after surgery; however, cTnT elevation was observed in nearly all subjects, with a median cTnT concentration of 1.08 ng/mL overall.

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Section: Mohammed Et Al Troponin T After Cardiac Surgery 847mentioning

confidence: 77%

Prospective, Comprehensive Assessment of Cardiac Troponin T Testing After Coronary Artery Bypass Graft Surgery

et al. 2009

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“…Myocardial injury was defined as PMI and/or a cTnI Ն13.1 ng ⅐ mL Ϫ1 12 hours after reperfusion. 8,9 LCOE, assessed by a blinded committee, was defined as a CI Յ2.1 L ⅐ min Ϫ1 m Ϫ2 with a central venous pressure Ն12 mm Hg and pulmonary capillary wedge pressure Ն14 mm Hg in the presence of a native or paced synchronized heart rate Ͼ70 min Ϫ1 . The individual total weight indexed dose of inotrope and vasoconstrictor use were calculated.…”

Section: End Pointsmentioning

confidence: 99%

Glucose-Insulin-Potassium and Tri-Iodothyronine Individually Improve Hemodynamic Performance and Are Associated With Reduced Troponin I Release After On-Pump Coronary Artery Bypass Grafting

et al. 2006

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Background— Both glucose-insulin-potassium (GIK) and tri-iodothyronine (T3) may improve cardiovascular performance after coronary artery surgery (CABG) but their effects have not been directly compared and the effects of combined treatment are unknown. Methods and Results— In 2 consecutive randomized double-blind placebo-controlled trials, in patients undergoing first time isolated on-pump CABG between January 2000 and September 2004, 440 patients were recruited and randomized to either placebo (5% dextrose) (n=160), GIK (40% dextrose, K + 100 mmol · L −1 , insulin 70 u · L −1 ) (0.75 mL · kg −1 h −1 ) (n=157), T3 (0.8 μg · kg −1 followed by 0.113 μg · kg −1 h −1 ) (n=63) or GIK+T3 (n=60). GIK/placebo therapy was administered from start of operation until 6 hours after removal of aortic cross-clamp (AXC) and T3/placebo was administered for a 6-hour period from removal of AXC. Serial hemodynamic measurements were taken up to 12 hours after removal of AXC and troponin I (cTnI) levels were assayed to 72 hours. Cardiac index (CI) was significantly increased in both the GIK and GIK/T3 group in the first 6 hours compared with placebo ( P <0.001 for both) and T3 therapy ( P =0.009 and 0.029, respectively). T3 therapy increased CI versus placebo between 6 and 12 hours after AXC removal ( P =0.01) but combination therapy did not. Release of cTnI was lower in all treatment groups at 6 and 12 hours after removal of AXC. Conclusions— Treatment with GIK, T3, and GIK/T3 improves hemodynamic performance and results in reduced cTnI release in patients undergoing on-pump CABG surgery. Combination therapy does not provide added hemodynamic effect.

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“…In addition to a sufficient revascularization, elective myocardial protection is needed for the ventricular function to be maintained. There are various factors affecting postoperative myocardial function and extent of myocardial injury (6,7). Despite the great number of studies conducted, the mechanism of action of volatile anesthetic agents with regard to myocardial injury is not entirely elucidated.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the effects of sevoflurane and isoflurane on myocardial protection in coronary bypass surgery

Ceyhan

Tanriverdi²,

Bilir³

2011

Anadolu Kardiyol Derg

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ÖZETAmaç: Bu prospektif randomize çalışmanın amacı sevofluran ve isofluranın koroner baypas cerrahisi sırasında miyokart üzerindeki koruyucu etkilerini karşılaştırmaktır. Yöntemler: Etomidat (0.3 mg /kg ) ile genel anestezi indüksiyonunu takiben 0.1 mg/kg pankuronyum ve 1 mikrogr/kg remifentanil bolus olarak verildi. Anestezi idamesi Grup 1'deki hastalarda (n=20) %2-4 değerinde sevofluran, Grup 2'deki hastalarda (n=20) %1-2 değerinde isofluranla sağlandı. Anestezi indüksiyonundan önce, aortik klemp kaldırıldıktan sonra ve postoperatif periyotta arteriyel kan örnekleri alındı. Bu örneklerde Troponin T, kreatinin kinaz ve kreatinin kinaz MB değerleri ölçüldü. İstatistiksel analizler -iki-yönlü ANOVA ve Mann-Whitney testleri ile yapıldı. Bulgular: Kalp hızı sevofluran grubunda pompa periyodunda, pompadan çıkış sonrası 10. ve 20. dakikalarda anlamlı yüksek bulunmuştur. CKMB düzeyi postoperatif 24. saatte sevofluran grubunda isofluran grubuna göre anlamlı düşüktür. Troponin T kros-klemp kaldırıldıktan sonra (1.015 (0.935-1.850) ng/ml, 1.469 (1.290-1.645) ng/ml, p<0.001) ve postoperatif 24.saatte (5.345±0.654 ng/ml, 8.715±1.020 ng/ml, p<0.001) sevofluran grubunda isofluran grubu ile karşılaştırıldığında anlamlı düşüktür. Sonuç: Miyokardiyal hasarlanma işaretleyicileri olan troponin T ve CKMB düzeylerinin daha düşük düzeylerde saptanması ile sevofluranın isoflurana göre miyokardiyal korumayı daha iyi sağlamakta olduğu kanısındayız. (Anadolu Kardiyol Derg 2011; 11: 257-62) Anahtar kelimeler: Sevofluran, isofluran, miyokardiyal koruma, koroner baypas cerrahisi ABSTRACT Objective: The aim of this prospective randomized study was to compare the myocardial protective effects of sevoflurane and isoflurane during coronary bypass surgery. Methods: After induction of general anesthesia with etomidate 0.3 mg/kg, a bolus dose of pancuronium 0.1 mg/kg and remifentanil 1 mcg/kg was administered. For the maintenance of anesthesia, patients received either sevoflurane (n=20) at 2-4% or isoflurane (n=20) at 1-2%. Arterial blood samples were obtained as follows: before induction of anesthesia, after aortic unclamping, at postoperative period. Troponin-T, creatine kinase (CK), and creatine kinase-MB (CKMB) values were measured in all obtained samples. Statistical analysis was performed using two-way ANOVA analysis and Mann-Whitney test. Results: Heart rate was significantly higher in the sevoflurane group during the aortic side-clamp period, at the 10 th minute and 20 th minute after cardiopulmonary bypass (CPB) ending. The CK-MB values at 24 th postoperative hour in the sevoflurane group were found to be significantly lower from the isoflurane group. The troponin-T values following the removal of the cross-clamp (1.015 (0.935-1.850) ng/ml vs 1.469 (1.290-1.645) ng/ml, p<0.001) and those at the 24 th postoperative hour (5.345±0.654 ng/ml vs 8.715±1.020 ng/ml, p<0.001) were significantly lower in the sevoflurane group when compared to those in the isoflurane group. Conclusion: Sevoflurane provides a better myocardial protection than isof...

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Cardiac Troponin I Release After Coronary Artery Bypass Grafting Operation: Effects on Operative and Midterm Survival

Cited by 48 publications

References 22 publications

Prospective, Comprehensive Assessment of Cardiac Troponin T Testing After Coronary Artery Bypass Graft Surgery

Prospective, Comprehensive Assessment of Cardiac Troponin T Testing After Coronary Artery Bypass Graft Surgery

Glucose-Insulin-Potassium and Tri-Iodothyronine Individually Improve Hemodynamic Performance and Are Associated With Reduced Troponin I Release After On-Pump Coronary Artery Bypass Grafting

Comparison of the effects of sevoflurane and isoflurane on myocardial protection in coronary bypass surgery

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