Diagnosis of perioperative myocardial infarction after heart valve surgery with new cut-off point of high-sensitivity troponin T and new electrocardiogram or echocardiogram changes

Cubero-Gallego, Héctor; Lorenzo, Mario; Heredia, María; Gómez, Itzíar; Tamayo, Eduardo

doi:10.1016/j.jtcvs.2017.02.013

Cited by 21 publications

(22 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our study, the nonsurvivors group of perioperative MI had significantly preoperative CKD with GFR less than 60 (mL/min/1.73 m 2 ) and postoperative AKI and haemodialysis as compared to the survivors group. Our results were similar to other studies that confirmed the greater postcardiotomy morbidity and mortality with decreased renal functions [33,34]. Interestingly, we found that the frequency of AKI and use of haemodialysis were significantly greater in the reoperation group than in the PCI group despite the risk of contrast-induced nephropathy in those unstable patients.…”

Section: Discussionsupporting

confidence: 91%

See 1 more Smart Citation

Outcome of Postcardiac Surgery Acute Myocardial Infarction and Role of Emergency Percutaneous Coronary Interventions

Laimoud

Qureshi

2020

Cardiology Research and Practice

View full text Add to dashboard Cite

Background. Cardiac surgery carries a well-known risk of perioperative myocardial infarction (MI), which is associated with high morbidity and both in-hospital and late mortality. The rapid haemodynamics deterioration and presence of myocardial ischemia early after cardiac surgical operations is a complex life-threatening condition where rapid diagnosis and management is of fundamental importance. Objective. To analyse the factors associated with mortality of patients with postcardiotomy MI and to study the role of emergency coronary angiography in management and outcome. Methods. We retrospectively enrolled adult patients diagnosed to have postcardiotomy MI and underwent emergency coronary angiography at our tertiary care hospital between January 2016 and August 2019. Results. Sixty-one patients from consecutive 1869 adult patients who underwent cardiac surgeries were enrolled in our study. The studied patients had a mean age of 49 ± 16.2 years with a mean BMI of 29.5 ± 6.6 and 65.6% of them were males. As compared to the survivors group, the nonsurvivors of perioperative MI had significant preoperative CKD, postoperative AKI, longer CPB time, frequent histories of previous PCI, previous cardiotomies, pre and postoperative ECMO use, higher median troponin I levels, higher peak and 24 hours median lactate levels. Regression analysis revealed that reoperation for revascularization (OR: 23; 95% CI: 8.27–217.06; P=0.034) and hyperlactataemia (OR: 3.21; 95% CI: 1.14–9.04; P=0.027) were independent factors associated with hospital mortality after perioperative MI. Hospital mortality occurred in 25.7% vs 86.7% (P<0.001), AKI occurred in 37.1% vs 93.3% (P<0.001), haemodialysis was used in 28.6% vs 80% (P=0.002), and mediastinal exploration for bleeding was performed in 31.4% vs 80% (P=0.006) in the PCI and reoperation groups, respectively, while there were no significant differences regarding gastrointestinal bleeding, cerebral strokes, or intracerebral bleeding. The median peak troponin level was 795 (IQR 630–1200) vs 4190 (IQR 3700–6300) (P<0.001) in the PCI and reoperation groups, respectively. Absence of significant angiographic findings occurred in 18% of patients. Conclusions. Perioperative MI is associated with significant morbidities and hospital mortality. Reoperation for revascularization and progressive hyperlactataemia are independent predictors of hospital mortality. Emergency coronary angiography is helpful in diagnosis and management of perioperative MI.

show abstract

Section: Discussionsupporting

confidence: 91%

“…e CPB time is well known as an independent risk factor of postcardiotomy morbidity and mortality [35]. Cubero-Gallego et al [34] found that the CPB time was longer in patients with perioperative MI after valve surgery than those without perioperative MI.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Postcardiac Surgery Acute Myocardial Infarction and Role of Emergency Percutaneous Coronary Interventions

Laimoud

Qureshi

2020

Cardiology Research and Practice

View full text Add to dashboard Cite

show abstract

“…In another meta-analysis performed by Sa et al, they showed that there was no significant difference between patients using crystalloid cardioplegia solution and those with blood cardioplegia solution in terms of developing LCOS [26]. Increased CK-MB and troponin I values in the postoperative period estimate the myocardial damage in patients undergoing cardiac arrest with CPB [27]. In our study, there were no difference in CK-MB and troponin I levels between the groups, which were examined consecutively.…”

Section: Discussionmentioning

confidence: 39%

Evaluation of the cardioprotective effects of crystalloid del Nido cardioplegia solution via a rapid and accurate cardiac marker: heart-type fatty acid-binding protein

Kirişçi¹,

Koçarslan²,

Aykan³

et al. 2020

Turk J Med Sci

View full text Add to dashboard Cite

Background/aim: Our aim in this study was to compare the efficacy and safety of crystalloid del Nido solution and cold blood cardioplegia solution on clinical and laboratory parameters. Materials and methods: Sixty patients who underwent elective coronary bypass operation between July 2019 and January 2020 were included in our study. Patients were divided into 2 groups of 30 patients using del Nido solution (DNS) and cold blood cardioplegia solution (CBCS), which were given for cardiac arrest. Demographic data, preoperative, postoperative 0th h, 6th h and 4th day creatine kinase myocardial band (CK-MB) and troponin I values were compared with a specific cardiac enzyme heart-type fatty acid-binding protein (H-FABP). Results: We found that aortic cross clamp duration and cardiopulmonary bypass (CPB) time were shorter in patients using del Nido solution than cold blood cardioplegia solution (57.30 ± 23.57 min, 76.07 ± 27.18 min, P = 0.006) (95.07 ± 23.06 min, 114.13 ± 33.93, P = 0.014). Total cardioplegia solution volume was higher in the cold blood cardioplegia solution group (1426.67 ± 416.00 vs. 1200 ± 310.73 P = 0.02). Preoperative and postoperative levels of cardiac enzymes including CK-MB, troponin I and H-FABP were comparable in del Nido solution and cold blood cardioplegia solution groups. Conclusion: According to these results, when we compare both demographic data and CK-MB, troponin I and H-FABP levels, both cardioplegia solutions were comparable regarding safety and efficacy in terms of myocardial protection.

show abstract

“…Cardiac tamponade and degree of PVL were determined by echocardiography. Diagnosis of myocardial infarction was based on the elevation of high‐sensitivity cardiac troponin T and creatine kinase isoenzyme, the onset of new pathologic Q‐waves or new left bundle branch block, or the imaging evidence of new wall motion abnormality 15,16 . The cerebrovascular accident was determined by CT or magnetic resonance imaging of the head in the presence of new onset of neurological deficit.…”

Section: Methodsmentioning

confidence: 99%

The benefit of fibrosa layer stripping technique during minimally invasive aortic valve replacement for calcified aortic valve stenosis—A randomized controlled trial

et al. 2020

View full text Add to dashboard Cite

Background: Fibrosa layer stripping (FLS) technique is a new approach to remove the calcified aortic valve. In this study, we aimed to assess the effectiveness of the FLS technique by comparing it with the conventional technique in minimally invasive aortic valve replacement (MIAVR). Methods: A prospective, single-center, randomized controlled trial was conducted at Beijing Anzhen Hospital. Seventy patients diagnosed with severe calcific aortic stenosis were randomly assigned to undergo FLS (n = 35) or conventional (n = 35) technique to debride calcified aortic valve. Preoperative profile, procedural parameters, and postoperative outcomes were analyzed. Results: No significant difference was observed in the preoperative profile between the two groups. Compared with the conventional technique, the FLS technique had a significantly higher indexed effective orifice area and lower mean gradient. Moreover, the FLS technique was associated with significantly reduced aortic cross-clamp time (41 [38-44] vs. 56 [51-60] min, p < .001), cardiopulmonary bypass (CPB) time (63 [56-69] vs. 81 [75-84] min, p < .001), and operative time (148 [141-156] vs. 173 [169-180] min, p < .001). Lastly, the length of intensive care unit stay (1.2 ± 0.4 vs. 1.5 ± 0.8 days, p = .041) and hospital stay (5.3 ± 0.6 vs. 6.0 ± 1.4 days, p = .020) was significantly reduced in the FLS group compared with those in the conventional group. Conclusions: FLS technique is effective in removing calcified tissue during MIAVR and is associated with shorter cross-clamp time and CPB time, and better hemodynamic performance than the conventional technique.

show abstract

Diagnosis of perioperative myocardial infarction after heart valve surgery with new cut-off point of high-sensitivity troponin T and new electrocardiogram or echocardiogram changes

Abstract: Cut-offs for hs-cTnT and CK-MB to diagnose perioperative MI after heart valve surgery are well above upper reference limit. These findings update the Third Universal Definition providing cut-offs to diagnose perioperative MI after heart valve surgery.

Cited by 21 publications

References 30 publications

Outcome of Postcardiac Surgery Acute Myocardial Infarction and Role of Emergency Percutaneous Coronary Interventions

Outcome of Postcardiac Surgery Acute Myocardial Infarction and Role of Emergency Percutaneous Coronary Interventions

Evaluation of the cardioprotective effects of crystalloid del Nido cardioplegia solution via a rapid and accurate cardiac marker: heart-type fatty acid-binding protein

The benefit of fibrosa layer stripping technique during minimally invasive aortic valve replacement for calcified aortic valve stenosis—A randomized controlled trial

Contact Info

Product

Resources

About