Effect of Fast Cardioplegic Arrest Induced by Adenosine on Cardiac Troponin Levels After Heart Valve Surgery

Abdelwahab, Amr A.; Sabry, Mohab; El-Shora, Hatem; Arafat, Amr A.

doi:10.1016/j.hlc.2018.08.017

Cited by 8 publications

(16 citation statements)

References 13 publications

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“…Several risk factors affect the outcome of aortic surgery and are not included in the risk score systems such as the type of the prosthesis [14], and several intraoperative factors have a significant effect on the postoperative course [15]. Comprehensive echocardiographic details are not included in most cardiac risk scoring systems, and no echocardiographic finding predicted the mortality in our series.…”

Section: Discussionmentioning

confidence: 93%

Predictors of Early Mortality After Aortic Valve Replacement in Middle-Aged Rheumatic Patients

Hassan

Sersar

2019

Egypt. Cardiothoracic. Surg.

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Background: Several risk factors, including emergency surgery, predicted early mortality after aortic valve replacement (AVR). Euroscore II is used to predict the mortality after cardiac operations. We aimed to review our experience in AVR and determine the early mortality predictors Methods: We collected the data of 200 rheumatic patients who had standard AVR in two centers. Median sternotomy and cardiopulmonary bypass were used in all patients. Transcatheter and minimally invasive aortic valve replacement patients were excluded. We used 15 types of aortic valve prostheses, either mechanical or biological. Follow-up echocardiography was done in the intensive care unit, on discharge, and one month after discharge. Results: 128 patients (64%) had mechanical AVR, and 130 patients (65%) were males. The mean age was 48.2 ± 19 years, and body mass index was 1.8 ± 0.2 Kg/m2. The mean preoperative ejection fraction was 54 ± 9.4 %, end-diastolic dimension was 5.3 ± 0.8 cm, and end-systolic dimension was 3.5 ± 0.9 cm. Nine patients (4.5%) died in the early postoperative period (6 months). Euroscore II was the only factor significantly associated with early mortality (P value= 0.031). The mean Euroscore II was 1.3 ± 0.9 and 10.1 ± 10.7 for survivors and non-survivors, respectively. Conclusion: Euroscore II score was significantly associated with early mortality after aortic valve replacement in rheumatic patients and can be used for risk stratification in those patients.

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Section: Discussionmentioning

confidence: 93%

Predictors of Early Mortality After Aortic Valve Replacement in Middle-Aged Rheumatic Patients

Hassan

Sersar

2019

Egypt. Cardiothoracic. Surg.

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“…The mean age was 55.67±5.3 years for group I and 53.86±5.3 for group II. As shown in table (1), there was no statistical difference between the two groups as to their age and gender distribution.…”

Section: Preoperative Datamentioning

confidence: 85%

“…The level of preoperative troponin was also (0.03657±.02957) in the cold group (I) and (0.0416±0.03102) in the warm group (II). Table (1).…”

Section: Preoperative Datamentioning

confidence: 99%

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Comparison Study: Intermittent Antigrade Warm Cardioplegia Versus Antigrade Cold Intermittent Blood Cardioplegia for Myocardial Protection During Elective on Pump Coronary Artery Bypass Grafting in Early Post-Operative Period

El-Safty¹,

ijar²,

Bakr³

et al. 2020

IJAR

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Background: Defending the heart against potential damage during cross-clamping is the most important and vital step to ensuring a successful surgical outcome(1). The creation of cardioplegia solutions was one of the major advances in cardiac surgery that allowed surgeons to conduct complicated surgical procedures to avoid myocardial injury (14). Treating cardioplegia at a cool temperature would be a significant factor in lowering myocardial metabolism. However, the reduction in myocardial metabolism due to hypothermia, compared with that achieved by diastolic arrest, is usually very negligible. Since Normothermias enzymatic and cellular processes work better (7). Owing to the propensity of the heart to resume electrical operation during normothermia, however, this must be administered consistently or only with short interruptions (4). Terminal warm blood cardioplegia (hot shot) is normally done just before the elimination of the aortic cross-clamp since it has been demonstrated that myocardial metabolism is increasing (23). Methods: A prospective controlled randomised study (200 hundred patients aged 40 to 65 years of both sexes underwent elective CABG pump surgery) will be included. They will be divided into three groups of patients: Group I:includes 100 Patients who received intermittent cold blood cardioplegia. Group II:includes 100 Patients who received intermittent warm blood cardioplegia with controlled reperfusion for 3 minutes before aortic unclamping. Study made from January, 2019 to August, 2020, at National Heart Institute.All patients were thoroughly evaluated preoperatively, intraoperatively, and postoperatively. Results: We hypothesized that in our patient cohort, warm blood cardioplegia could be as successful as or even better than the conventional antegrade cold blood cardioplegia. Patients were randomised into two similar blocks, each of which consisted of 100 patients, each of whom obtained one of the two cardioplegic solutions. Our analysis did not indicate a statistically important difference in the post-operative release of myocardial biomarkers (Troponin I) & CK in both classes. This finding did not significantly reflect the clinical outcome of our patient, which may indicate similar myocardial protection in primary low-risk CABG patients for both cold and warm blood cardioplegia. Conclusion: During the time of cardiac arrest, both methods tend to enable an equal and adequate approach for myocardial defence. To attain improved myocardial defence, warm blood cardioplegia needs a shorter administration interval. Therefore, the choice between one type of cardioplegia and the other remains at the discretion of the surgeon. The statistically minor variation found in the release of myocardial enzymes did not translate into distinct clinical results.

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“…Early recognition of perioperative myocardial damage is essential to prevent complications post-CABG surgery [9,10]. Different biomarkers were used for the detection of myocardial damage like CK-MB, myoglobin, lactate dehydrogenase (LDH), brain natriuretic peptide, and troponin [11]. Each biomarker has its drawbacks, and the predictability of each biomarker varies widely in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Could heart-type fatty acid binding protein predict clinical outcome in coronary artery bypass graft surgery?

Aboelnasr

Elfeky

Ali

et al. 2019

Egypt. Cardiothoracic. Surg.

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Background: Detection of myocardial damage and its degree during open heart surgery were studied previously using different biomarkers. Heart fatty acid binding protein (h-FABP) was used in the diagnosis of myocardial infarction with variable results. In this study, we aimed to find the possibility of the use of this biomarker as a predictor of myocardial damage after coronary artery bypass graft (CABG) surgery. Methods: We conducted a prospective study on 47 patients who had CABG surgery. Blood samples (4 ml) were drawn from patients at 5 points: before induction of anesthesia, after aortic declamping, 1 hour after declamping, 6 hours after declamping and one day after surgery. Levels of h-FABP and creatine kinase muscle/brain (CK-MB) were estimated, and the relationship between h-FABP and operative and postoperative outcomes were recorded. Results: There were statistically significant correlations between higher levels of h-FABP measured immediately after aortic declamping and need for intra-aortic balloon (116.55 + 9.26 vs, 84.34 + 19.55 ng/ml; p= 0.022), inotropes (107.04+ 14.79 vs, 79.95 + 17.59ng/ml; p< 0.001), defibrillators (97.73 + 15.18 vs 81.59 + 20.31 ng/ml; p=0.016), and postoperative atrial fibrillation (99.94 + 17.83 vs 80.84 + 18.89ng/ml; p= 0.004). No mortality was detected in our study. h-FABP levels showed an early peak just after aortic declamping and reached baseline by postoperative day one. CK-MB peaked 1 hour after aortic declamping and remained elevated for more than 24 hours. Conclusion: h-FABP is a cardiac biomarker that could be used as a rapid indicator of ventricular dysfunction and atrial fibrillation post-CABG surgery.

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Effect of Fast Cardioplegic Arrest Induced by Adenosine on Cardiac Troponin Levels After Heart Valve Surgery

Cited by 8 publications

References 13 publications

Predictors of Early Mortality After Aortic Valve Replacement in Middle-Aged Rheumatic Patients

Predictors of Early Mortality After Aortic Valve Replacement in Middle-Aged Rheumatic Patients

Comparison Study: Intermittent Antigrade Warm Cardioplegia Versus Antigrade Cold Intermittent Blood Cardioplegia for Myocardial Protection During Elective on Pump Coronary Artery Bypass Grafting in Early Post-Operative Period

Could heart-type fatty acid binding protein predict clinical outcome in coronary artery bypass graft surgery?

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