Postoperative Serum Troponin Trends in Infants Undergoing Cardiac Surgery

被引:17
作者
Su, Jennifer A. [1 ,2 ]
Kumar, S. Ram [2 ,3 ,4 ]
Mahmoud, Hesham [2 ]
Bowdish, Michael E. [3 ]
Toubat, Omar [2 ,3 ]
Wood, John C. [1 ,2 ,4 ]
Kung, Grace C. [1 ,2 ,4 ]
机构
[1] Univ Southern Calif, Div Cardiol, Los Angeles, CA USA
[2] Childrens Hosp Los Angeles, Inst Heart, Los Angeles, CA 90027 USA
[3] Univ Southern Calif, Keck Sch Med, Dept Surg, Div Cardiothorac Surg, Los Angeles, CA USA
[4] Univ Southern Calif, Dept Pediat, Los Angeles, CA USA
关键词
Infant; Congenital heart disease; Cardiac surgery; Troponin-I; Biomarker; MYOCARDIAL INJURY; PROGNOSTIC VALUE; I MEASUREMENT; PATTERNS;
D O I
10.1053/j.semtcvs.2018.08.010
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 48 hours 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 4 hours after surgery and returned to near-normal levels within 48 hours. A persistent TN-I rise beyond 8 hours 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 8 hours after surgery is strongly associated with postoperative hypoperfusion injury and mortality. © 2018 Elsevier Inc.
引用
收藏
页码:244 / 251
页数:8
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