Effects of age and ischemic times on biochemical evidence of myocardial injury after pediatric cardiac operations

Taggart, David P.; Hadjinikolas, L.; Hooper, James; Albert, James D.; Kemp, Michael; Hue, Dominic; Yacoub, Magdi H.; Lincoln, Joy

doi:10.1016/s0022-5223(97)70231-9

Cited by 72 publications

(59 citation statements)

References 16 publications

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“…The restrictive group had both higher troponin T peak and higher AUC values than the nonrestrictive group, and indeed, the peak values in the restrictive group were in the extreme end of the range found in a previous pediatric series of patients undergoing open-heart surgery in our 16,17 and other 27 institutions. In addition, the peak troponin T values for patients with restrictive physiology were 3 to 4 times higher than previously reported values for adults undergoing coronary artery surgery 28,29 or heart transplantation 30 and lie in the upper range reported for adults with myocardial infarction.…”

Section: Myocardial Injurysupporting

confidence: 70%

Acute Right Ventricular Restrictive Physiology After Repair of Tetralogy of Fallot

et al. 1999

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Background —Acute right ventricular (RV) restrictive physiology after tetralogy of Fallot repair results in low cardiac output and a prolonged stay in the intensive care unit (ICU). However, its mechanism remains uncertain. Methods and Results —In the first 24 hours after tetralogy of Fallot repair (n=11 patients), serial prospective measurements were performed of cardiac troponin T, indexes of NO production (NO 2 − and NO 3 − combined as NOx), and iron metabolism and antioxidants. RV diastolic function was assessed by transthoracic Doppler echocardiography. Patients who had a long stay in the ICU were characterized by restrictive RV physiology (nonrestrictive group [n=7]: 3.0±0.6 days [mean±SD]; restrictive group [n=4]: 10.7±3.1 days). Troponin T peak concentration and the area under its concentration-time curve (AUC) were higher in the restrictive RV group (peak: restrictive group 17.0±2.8 μg/L, nonrestrictive group 10.4±4.6 μg/L, P <0.03; AUC: restrictive group 268.8±73.6 μg · h −1 · L −1 , nonrestrictive group 136.2±48.3 μg · h −1 · L −1 , P <0.03). Plasma NOx/creatinine concentrations were higher in the restrictive group than the nonrestrictive group at 2 hours after bypass (restrictive group 1.3±0.4, nonrestrictive group 0.8±0.2; P =0.04) but were similar by 24 hours. Iron loading peaked 2 to 10 hours after bypass and was more severe in the restrictive group (peak transferrin saturation: restrictive group 83.9±13.0%, nonrestrictive group 58.3±16.2%, P =0.05; minimum total iron-binding capacity: restrictive group 0.59±0.21%, nonrestrictive group 0.76±0.06%, P =0.04; minimum iron-binding antioxidant activity to oxyorganic radicals: restrictive group 9.5±22.4%, nonrestrictive group 50.6±11.4%, P =0.01). Conclusions —After tetralogy of Fallot repair, acute restrictive RV physiology is associated with greater intraoperative myocardial injury and postoperative oxidative stress with severe iron loading of transferrin.

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Section: Myocardial Injurysupporting

confidence: 70%

Acute Right Ventricular Restrictive Physiology After Repair of Tetralogy of Fallot

et al. 1999

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“…24 The cTnT levels were significantly higher in the circulatory arrest group compared with the CPB group. The longer aortic cross-clamp or circulatory arrest time resulted in more myocardial cell injury.…”

Section: Discussionmentioning

confidence: 85%

Effect of Two Different Bypass Techniques on the Serum Troponin-T Levels in Newborns and Children

et al. 2003

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“…Following pediatric surgery, intubation and intensive care unit stay time which have effects on morbidity and mortality, were found significantly longer, as shown in our study (19) . Despite, high levels of troponin I in infant population; Bojan et al declared the unnecessity of routine troponin I use in infants under 1 years old (12,13,20) . Consequently, the use of cardiac markers has been increasing during treatment of patients with congenital heart disease; however, there is no valid guideline regarding the routine use of these markers.…”

Section: Discussionmentioning

confidence: 99%

Relation of Troponin I Levels with Postoperative Mortality and Morbidity Rates in Patients Followed in Intensive Care Unit After Congenital Cardiac Surgery Whose Ages Between 7 Days and 16 Years Old

Ak¹,

Yıldız²,

Yurtseven³

et al. 2018

Kosuyolu Heart Journal

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Introduction: Troponin I levels are the most important predictive marker of myocardial injury. Myocardial injury has been reported as the most significant cause of morbidity and mortality in pediatric cardiac surgery. In this study, we aimed to evaluate the effect of troponin I on postoperative mortality and morbidity in the child population. Patients and Methods:Ninety-nine patients to whom congenital cardiac surgery were included in this study. Perioperative and postoperative troponin I values at 24 th and 48 th hours were recorded. Patients were divided into two groups according to troponin I values at 24 th hour (lower and higher than 15 ng/mL, respectively). Aortic cross-clamp time, cardiopulmonary bypass (CPB) time, intubation time, and the duration of intensive care unit stay and medication of inotropic agents were recorded.Results: Postoperative troponin I levels at 24 th hour were higher than 15 ng/mL in patients who underwent congenital cardiac surgery and were related with significantly higher CPB, aortic cross-clamp, intubation time, and longer stay in intensive care unit. Conclusion:Higher troponin I levels at 24 th hour are associated with increased morbidity in patients who undergo congenital cardiac surgery. Hastalar ve Yöntem:Konjenital kardiyak cerrahi uygulanan 99 hastanın perioperatif, postoperatif 24. ve 48. saatteki troponin I değerleri kaydedildi. Hastalar hesaplanan cut off değerine göre 24. saat troponin I seviyelerine göre iki gruba ayrıldı (15 ng/mL'den yüksek olanlar ve olmayanlar). Hastaların aortik kros klemp süreleri, kardiyopulmoner baypas süresi, entübasyon süresi, yoğun bakımda kalış süresi ve inotropik ajan düzeyleri kaydedildi. Bulgular: Konjenital kalp ameliyatı olan hastalarda postoperatif 24. saatte ölçülen troponin I seviyelerinin 15 ng/mL'nin üzerinde olmasının: kardiyopulmoner baypas süresi, aortik kross klamp süresi, entübasyon süresi ve yoğun bakım kalış süresini anlamlı olarak arttırdığı gösterildi.Sonuç: Konjenital kalp ameliyatı olan hastalarda postoperatif 24. saat yüksek troponin I düzeyleri yüksek morbidite riski ile uyumludur.

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Effects of age and ischemic times on biochemical evidence of myocardial injury after pediatric cardiac operations

Cited by 72 publications

References 16 publications

Acute Right Ventricular Restrictive Physiology After Repair of Tetralogy of Fallot

Acute Right Ventricular Restrictive Physiology After Repair of Tetralogy of Fallot

Effect of Two Different Bypass Techniques on the Serum Troponin-T Levels in Newborns and Children

Relation of Troponin I Levels with Postoperative Mortality and Morbidity Rates in Patients Followed in Intensive Care Unit After Congenital Cardiac Surgery Whose Ages Between 7 Days and 16 Years Old

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