Postoperative Serum Troponin Trends in Infants Undergoing Cardiac Surgery

Abstract

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.

High-sensitivity Troponin-t Level after Pediatric Congenital Heart Disease Surgery

“…An important observation in the study was that the level of the 24-hour troponin measurements showed a decrement from that of the 4-hour troponin measurement in all of the cases except one. (Su et al, 2019) also found the same result; the troponin T tends to decrease gradually from the 4-hour and on after the operation.…”

“…The relation between troponin levels and the type of surgery showed statistically higher levels in TOF cases, and about 50% of TOF surgeries had troponin levels between 2 and 4 ng/ml. It is stated that high troponin is associated with complex congenital heart surgery (Su et al, 2019;Wada et al, 2018). Moderately positive, statistically significant correlations for both 4-and 24-hour troponin levels were detected with CPB, ACC, and operation durations.…”

“…The time to measure the troponin is a subject of debate in children. Also, the value that is regarded as a risky cut-off remains controversial (Thygesen et al, 2018;Wu et al, 2018;Bohn et al, 2019;Kavsak et al, 2014;Su et al, 2019). Four and 24 hours after Intensive Care Unit (ICU) admission measurements have been chosen for comparison, and the earlier detection is the better, as it is shown by other studies to be more related to outcomes.…”

“…Four and 24 hours after Intensive Care Unit (ICU) admission measurements have been chosen for comparison, and the earlier detection is the better, as it is shown by other studies to be more related to outcomes. (Su et al, 2019;Immer et al, 1999).…”

The predictive value of pressure recording analytical method for the duration of mechanical ventilation in children undergoing cardiac surgery with an XGBoost-based machine learning model

“…Yang et al and Liu et al observed the nadir of cardiac output, the minimal central venous oxygen saturation, and the peak of BNP and lactate level at 8h after the surgery ( 22 , 37 ). Su et al revealed that the increase of troponin-I beyond 8h after CPB was a strong predictor of postoperative hypoperfusion in infants ( 38 ).…”