Procedure-Specific Relationships Between Postoperative Troponin T and a Composite of Mortality and Low Cardiac Output Syndrome: A Retrospective Cohort Analysis

Zhou, Shan; Diehl, Rachel; Sessler, Daniel I.; Liang, Chen; Mascha, Edward J.; Soltesz, Edward G.; Duncan, Andra E.

doi:10.1213/ane.0000000000005850

Cited by 3 publications

(3 citation statements)

References 20 publications

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“…4 Department of Nuclear Medicine, The A liated Hospital of Qingdao University, Qingdao 266000, China. 5 Surgical Operating Room, The A liated Hospital of Qingdao University, Qingdao 266000, China.…”

Section: Fundingmentioning

confidence: 99%

“…Another critical factor is ischemia/reperfusion injury caused by longer CPB time, cardioplegic arrest (CA) time and defective cardioplegic solutions. [3][4][5][6] his study aimed to evaluate the safety and e cacy of the myocardial protection strategy that shortening CA time during MVR + CABG by comprehensively evaluating perioperative and medium-term clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Myocardial protection strategy: Reducing cardiac arrest time to improve myocardial protection in patients undergoing mitral valve replacement accompanying coronary artery bypass grafting

Yan

Han

Wang

et al. 2023

Preprint

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Background: Compared with isolated mitral valve replacement (MVR) or isolated coronary artery bypass grafting (CABG), MVR + CABG surgery is associated with higher mortality and complication rate. This study investigated the safety and efficacy of the myocardial protection technique to short cardioplegic arrest time in patients who underwent MVR + CABG. Methods:This study enrolled patients diagnosed with mitral valve disease and coronary artery disease who underwent MVR + CABG between January 2014 and January 2022. The patients were divided into the CABG without cardioplegic arrest (CA) group (novel group) and CABG with CA group (conventional group) according to surgical methods. The baseline data of the two groups of patients were corrected by the propensity score matching (PSM) method. Endpoints assessed were operative mortality (OM), major morbidity (MM)and 5-year follow-up clinical outcomes. Results: 810 patients (256 in the novel group and 554 in the conventional group) were enrolled in this study. PSM resulted in a total of 460 patients (230 pairs). There was no significant difference in OM between the two groups (6.5% vs 10.8%, P= 0.098). The MM was significantly lower in the novel group than the conventional group (24.3% vs 33.9%, P= 0.024). Mean operation time (285 ± 55 vs 298 ± 60 minutes, P= 0.016), cardiopulmonary bypass (CPB) time (115 ± 33 vs 139 ± 38 minutes, P < 0.001), CA time (66 ± 11 vs 85 ± 16 minutes, P < 0.001), intensive care unit stay time (33.6 ± 12.3 vs 36.6 ± 14.5 hours, P = 0.017) and post-operative length of stay (11.1 ± 3.6 vs 11.9 ± 4.1 days, P = 0.027) were significantly shorter in the novel group than in the conventional group. There was no significant difference between the novel group and the conventional group in terms of death from any cause, valve-related complications, myocardial infarction and any repeat revascularisation in 5 years follow-up. Conclusions: The novel group is associated with excellent short-term outcomes and comparable medium-term outcomes for patients undergoing MVR + CABG. Myocardial protection strategy to short cardioplegic arrest time in patients undergoing MVR + CABG was surgically feasible, reproducible, and safe.

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Section: Fundingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Myocardial protection strategy: Reducing cardiac arrest time to improve myocardial protection in patients undergoing mitral valve replacement accompanying coronary artery bypass grafting

Yan

Han

Wang

et al. 2023

Preprint

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“…Biologically, anaemia, elevated Brain Natriuretic Peptide (BNP) and pro-BNP were identified in cohort studies [6][7][8]. Surgically, the main factors identified were urgent surgery, longer Cardiopulmonary bypass (CPB) and crossclamp times [9].…”

Section: Introductionmentioning

confidence: 99%

Low cardiac output syndrome after cardiac surgery: A retrospective analysis

Bechri,

Derkaoui,

Shimi

et al. 2023

ijmmr

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Low cardiac output syndrome is a prevalent complication observed after cardiac surgery, related to elevated rates of mortality and morbidity. The study aimed to pinpoint independent risk factors for low cardiac output through the analysis of post-cardiac surgery data. This is a single-centre, two-year retrospective study from January 2021 to December 2022, including all patients admitted to the A1 general intensive care unit for postoperative management of cardiac surgery. Variables from preoperative, intraoperative, and postoperative data were collected and evaluated with the statistical package for the social sciences, with a significance level set at p < 0.05. Overall, the median age was 44 years (22-80), with 60% being female. The prevalence of low cardiac output syndrome after cardiac surgery was 44% (n = 85). Significant risk factors for low cardiac output syndrome were identified: low preoperative left ventricular function (ejection fraction <40%), preoperative atrial fibrillation, impaired preoperative renal function, multiple valve replacement, prolonged extracorporeal circulation, and clamping time. Patients who experienced low cardiac output syndrome had longer hospital stays and a higher incidence of postoperative complications, including atrial fibrillation and kidney injury, as well as a higher mortality rate (7% versus 0%). Identification and treatment of low cardiac output syndrome can improve myocardial recovery and decrease mortality. A better understanding of its physiopathological mechanisms may help develop potential preventive strategies

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European Association of Cardio-Thoracic Surgery (EACTS) expert consensus statement on perioperative myocardial infarction after cardiac surgery

Gaudino,

Flather,

Capodanno

et al. 2024

European Journal of Cardio-Thoracic Surgery

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Cardiac surgery may lead to myocardial damage and release of cardiac biomarkers through various mechanisms such as cardiac manipulation, systemic inflammation, myocardial hypoxia, cardioplegic arrest and ischaemia caused by coronary or graft occlusion. Defining perioperative myocardial infarction (PMI) after cardiac surgery presents challenges, and the association between the current PMI definitions and postoperative outcomes remains uncertain. To address these challenges, the European Association of Cardio-Thoracic Surgery (EACTS) facilitated collaboration among a multidisciplinary group to evaluate the existing evidence on the mechanisms, diagnosis and prognostic implications of PMI after cardiac surgery. The review found that the postoperative troponin value thresholds associated with an increased risk of mortality are markedly higher than those proposed by all the current definitions of PMI. Additionally, it was found that large postoperative increases in cardiac biomarkers are prognostically relevant even in absence of additional supportive signs of ischaemia. A new algorithm for PMI detection after cardiac surgery was also proposed, and a consensus was reached within the group that establishing a prognostically relevant definition of PMI is critically needed in the cardiovascular field and that PMI should be included in the primary composite outcome of coronary intervention trials.

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Procedure-Specific Relationships Between Postoperative Troponin T and a Composite of Mortality and Low Cardiac Output Syndrome: A Retrospective Cohort Analysis

Cited by 3 publications

References 20 publications

Myocardial protection strategy: Reducing cardiac arrest time to improve myocardial protection in patients undergoing mitral valve replacement accompanying coronary artery bypass grafting

Myocardial protection strategy: Reducing cardiac arrest time to improve myocardial protection in patients undergoing mitral valve replacement accompanying coronary artery bypass grafting

Low cardiac output syndrome after cardiac surgery: A retrospective analysis

European Association of Cardio-Thoracic Surgery (EACTS) expert consensus statement on perioperative myocardial infarction after cardiac surgery

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