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

Year 2018, Volume: 21 Issue: 1, 43 - 48, 01.04.2018

Hülya Yılmaz Ak Mustafa Yıldız Nurgül Yurtseven Deniz Özsoy Doğaç Okşen Hakkı Kürşat Çetin

Abstract

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.

Keywords

Congenital cardiac surgery, troponin I, mortality, morbidity

Konjenital Kardiyak Cerrahi Sonrası Yoğun Bakım Ünitesinde Takip Edilen 7 Gün ile 16 Yaş Aralığındaki Hastalarda Troponin I Seviyelerinin Postoperatif Mortalite ve Morbidite ile İlişkisi

Abstract

Giriş: Troponin I miyokardiyal hasarın tahmininde önemli bir belirteçtir.
Pediyatrik kardiyak cerrahide miyokardiyal hasarın en önemli mortalite ve
morbidite nedeni olduğu anlaşılmıştır. Bu çalışma ile konjenital kalp ameliyatı
olan çocuklarda troponin I değerlerinin postoperatif mortalite ve morbidite
üzerine etkisini değerlendirmek amaçlanmıştır.

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.

Keywords

Konjenital kalp ameliyatı, mortalite, morbidite, troponin I

References

• 1. Lasocki S, Provenchère S, Bénessiano J, Vicaut E, Lecharny JB, Desmonts JM, et al. Cardiac troponin-I is an independent predictor of in-hospital death after adult cardiac surgery. Anesthesiology 2002;97:405-11.
• 2. Moon MH, Song H, Wang YP, Jo KH, Kim CK, Cho KD. Changes of cardiac troponin I and operative mortality of coronary artery bypass. Asian Cardiovasc Thorac Ann 2014;22:40-5.
• 3. Wu AHB. Increased troponin in patients with sepsis and septic shock: myocardial necrosis or reversible myocardial depression? Intensive Care Med 2001;27:959-61.
• 4. Jaffe AS. Biomarker odyssey. Clin Chim Acta 1999;284:197-211.
• 5. Flyer D. Report on the New England regional infant cardiac Program. Pediatrics. 1980;65:375-461.
• 6. Mildh LH, Pettilä V, Sairanen HI, Rautiainen PH. Cardiac Troponin T levels for risk stratification in pediatric open heart surgery. Ann Thorac Surg 2006;82:1643-9.
• 7. Montgomery VL, Sullivan JE, Buchino JJ. Prognostic value of pre-and postoperative cardiac Troponin I measurement in children having cardiac surgery. Pediatr Dev Pathol 2000;3:53-60.
• 8. Taggart DP, Hadjinikolas L, Wong K, Yap J, Hooper J, Kemp M, et al. Vulnerability of pediatric myocardium to cardiac surgery. Heart 1996;76:214-21.
• 9. Lipshultz SE, Rifai N, Sallan SE, Lipsitz SR, Dalton V, Sacks DB, et al. Predictive value of cardiac Troponin T pediatric patiens at risk for myocardial injury. Circulaton 1997;96:2641-8.
• 10. Immer FF, Stocker FP, Seiler AM, Pfammatter JP, Printzen G, Carrel TP. Comparison of Troponin-I and Troponin-T after pediatric cardiovascular operation. Ann Thorac Surg 1998;66:2073-7.
• 11. Hirsch R, Dent CL, Wood MK, Huddleston CB, Mendeloff EN, Balzer DT, et al. Patterns and potential value of cardiac Troponin I elevations after pediatric cardiac operations. Ann Thorac Surg 1998;65:1394-9.
• 12. Taggart DP, Hadjinikolas L, Hooper J, Albert J, Kemp M, Hue D, et al. Effects of age and ischemic times on biochemical evidence of myocardial injury after pediatric cardiac operations. J Thorac Cardiovasc Surg 1997;113:728-35.
• 13. Bojan M, Peperstraete H, Lilot M, Vicca S, Pouard P, Vouhé P. Early elevation of cardiac troponin I is predictive of short-term outcome in neonates and infants with coronary anomalies or reduced ventricular mass undergoing cardiac surgey. J Thorac Cardiovasc Surg 2012;144:1436-44.
• 14. Immer FF, Stocker F, Seiler AM, Pfammatter JP, Bachmann D, Printzen G, et al. Troponin-I for prediction of early postoperative course after pediatric cardiac surgery. J Am Coll Cardiol 1999;33:1719-23.
• 15. Bottio T, Vida V, Padalino M, Gerosa G, Stellin G. Early and long-term prognostic value of Troponin-I after cardiac surgery in newborns and children. Eur J Cardiothorac Surg 2006;30:250-5.
• 16. Gupta-Malhotra M, Kern JH, Flynn PA, Schiller MS, Quaegebeur JM, Friedman DM. Cardiac Troponin I after cardiopulmonary bypass in infants in comparison with older children. Cardiol Young 2013;23:431-5.
• 17. Momeni M, Poncelet A, Rubay J, Matta A, Veevaete L, Detaille T, et al. Does postoperative cardiac troponin-ı have any prognostic value in predicting midterm mortality after congenital cardiac surgery? J Cardiothorac Vasc Anesth 2017;31:122-7.
• 18. Imura H, Modi P, Pawade A, Parry AJ, Suleiman MS, Angelini GD, et al. Cardiac Troponin I in neonates undergoing the arterial switch operation. Ann Thorac Surg 2002;74:1998-2002.
• 19. Modi P, Imura H, Angelini GD, Pawade A, Parry AJ, Suleiman MS, et al. Pathology-related Troponin I release and clinical outcome after pediatric open heart surgery. J Card Surg 2003;18:295-300.
• 20. Saraiya NR, Sun LS, Jonassen AE, Pesce MA, Queagebeur JM. Serum cardiac Troponin-I elevation in neonatal cardiac surgery is lesion-dependent. J Cardiothorac Vasc Anesth. 2005;19:620-5.