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Pathology‐Related Differences in Cardiac Troponin I and Clinical Outcome After Paediatric Open‐Heart Surgery
Author(s) -
Modi P,
Imura H,
Caputo M,
Parry AJ,
Pawade* A,
Suleiman MS,
Angelini GD
Publication year - 2002
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1046/j.1540-8191.2002.01014_6.x
Subject(s) - medicine , troponin , cardiac surgery , cardiology , outcome (game theory) , surgery , intensive care medicine , myocardial infarction , mathematics , mathematical economics
Objectives: A prospective study to evaluate pathology‐related differences in cardiac troponin I (TnI) release and its relation to clinical outcome after paediatric open‐heart surgery. Backgound: The degree of perioperative myocardial injury is determined by the ischaemic duration but also by the pathology and preoperative state of the heart (acidosis or cyanosis). Cardiac TnI is a marker of myocardial injury but little is known about the differences in TnI release between different pathologies. Methods: Troponin I was measured in 133 consecutive children undergoing repair of atrial (ASD, n = 41 ) and ventricular septal defects (VSD, n = 46 ) and Tetralogy of Fallot (TOF, n = 46 ). The length of the right ventricular outflow tract (RVOT) incision in the latter was classified as either minimum (n = 33) or extended (n = 13) according to the normal diameter of the pulmonary valve to body weight. Results: There was no mortality. Postoperative TnI levels were lesion‐specific and did not correlate with clinical outcome for ASDs ( Table 1). For VSDs, peak TnI correlated with the durations of inotropic support (r = 0.69, p = 0.0001) , ventilation (r = 0.64, p < 0.0001) and intensive care unit (ICU) stay (r = 0.60, p < 0.0001) with infants (<1 year old, n = 29 ) showing higher peak TnI ( 4.11 ± 0.46 vs 2.49 ± 0.33ng/ml, p = 0.02 ) and worse clinical outcome than children. For TOF, peak TnI correlated with the duration of inotropic support (r = 0.51, p = 0.0004) , ventilation (r = 0.36, p = 0.02) and ICU stay (r = 0.55, p = 0.0001) whereas arterial oxygen saturation showed a negative correlation with these (r =−0.39 to −0.49, p < 0.05) . Those undergoing an extended RVOT incision had greater peak TnI and worse clincial outcome than those with a minimum RVOT incision ( Table 2). Conclusions: TnI is a reliable marker of early post‐operative recovery after repair of VSDs and TOF. Age (<1 year) for patients with VSDs and right ventriculotomy length in TOF are important determinants of clinical outcome. 1Patient CharacteristicsASD (n = 41)VSD (n = 46)TOF (n = 46)Age (months) 71.4 ± 6.925.3 ± 6.218.0 ± 2.9ACC time (min) 26.4 ± 2.7*39.2 ± 2.949.1 ± 3.6Inotrope duration (hours) 9.5 ± 1.4*37.2 ± 6.571.6 ± 9.0†Ventilation time (hours) 6.9 ± 1.1‡28.5 ± 5.954.8 ± 8.4†ICU stay (days) 1.4 ± 0.1*3.0 ± 0.45.2 ± 0.6†Hospital stay (days) 5.3 ± 0.1*9.3 ± 0.811.5 ± 1.0Peak TnI (ng/ml) 2.2 ± 0.2*3.5 ± 0.37.3 ± 0.7p < 0.05 versus other pathologies, †p < 0.05 versus VSD, ‡p < 0.0001 versus TOF.2
Minimum Versus Extended Incision in TOFMinimum (n = 33)Extended (n = 13)P valueO 2 sat (%) 84.2 ± 1.176.7 ± 2.5 0.003 ACC time 46.9 ± 4.154.8 ± 7.3 0.32 Inotrope duration (hours) 46.4 ± 6.2131.8 ± 18.1 <0.0001 Ventilation time (hours) 33.1 ± 5.2106.6 ± 19.5 <0.0001 ICU stay (days) 3.5 ± 0.39.3 ± 1.1 <0.0001 Hospital stay (days) 9.6 ± 0.715.7 ± 2.4 0.0023 Peak TnI 5.0 ± 0.412.9 ± 1.1 <0.0001