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Cardiac troponin I after cardiopulmonary bypass in infants in comparison with older children

Published online by Cambridge University Press:  20 July 2012

Monesha Gupta-Malhotra ,
Jeffrey H. Kern ,
Patrick A. Flynn ,
Myles S. Schiller ,
Jan M. Quaegebeur  and
Deborah M. Friedman
Monesha Gupta-Malhotra*
Affiliation:
Division of Pediatric Cardiology, The New York Presbyterian Hospital, Weill Medical College, Cornell University and College of Physicians and Surgeons, Columbia University, New York, United States of America Division of Pediatric Cardiology, Children's Memorial Hermann Hospital, University of Texas Medical School, Houston, Texas, New York, United States of America
Jeffrey H. Kern
Affiliation:
Division of Pediatric Cardiology, The New York Presbyterian Hospital, Weill Medical College, Cornell University and College of Physicians and Surgeons, Columbia University, New York, United States of America
Patrick A. Flynn
Affiliation:
Division of Pediatric Cardiology, The New York Presbyterian Hospital, Weill Medical College, Cornell University and College of Physicians and Surgeons, Columbia University, New York, United States of America
Myles S. Schiller
Affiliation:
Division of Pediatric Cardiology, The New York Presbyterian Hospital, Weill Medical College, Cornell University and College of Physicians and Surgeons, Columbia University, New York, United States of America Division of Pediatric Cardiology, The Children's Hospital at Montefiore, Bronx, New York, United States of America
Jan M. Quaegebeur
Affiliation:
Division of Pediatric Cardiology, The New York Presbyterian Hospital, Weill Medical College, Cornell University and College of Physicians and Surgeons, Columbia University, New York, United States of America
Deborah M. Friedman
Affiliation:
Division of Pediatric Cardiology, The New York Presbyterian Hospital, Weill Medical College, Cornell University and College of Physicians and Surgeons, Columbia University, New York, United States of America Division of Pediatric Cardiology, New York Medical College, Valhalla, New York, United States of America
*
Correspondence to: Dr M. Gupta-Malhotra, MBBS, FAAP, FACC, FASE, Associate Professor, Division of Pediatric Cardiology, Children's Memorial Hermann Hospital, University of Texas Health Science Center, 6410 Fannin, UTPB Suite 425, Houston 77030, Texas, United States of America. Tel: +1 713 500 5743; Fax: +1 713 500 5751; E-mail: monesha.gupta@uth.tmc.edu
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Abstract

Objective

At the present time, there is a trend towards performing open heart surgery at a younger age. Myocardium of infants has been thought to be more vulnerable to cardiopulmonary bypass in comparison with adults. For this study, we evaluated the degree of myocardial injury by measurement of cardiac troponin levels in infants in comparison with older children for similar surgeries.

Methods

Serum was collected before bypass, after bypass, and daily after surgery and serum cardiac troponin I level (micrograms per litre). The demographic data, cardiac diagnoses, types of surgery performed, and peri-operative parameters were collected.

Results

Of the 21 children enrolled consecutively, five were infants. Among the 21 patients, four patients had post-operative peak troponin values greater than 100 (three were infants) and all four patients survived and had normal left ventricular systolic function upon discharge echocardiogram. The five infants had peak troponin levels of 222.3, 202, 129, 26.7, and 82.3. The post-operative peak troponin levels were significantly higher in infants (mean 132.5 with a standard deviation of 81.6) than in the older children (mean 40.3 with a standard deviation of 33.4), although there was no significant difference in bypass time, bypass temperature, cross-clamp time, or the length of stay in the intensive care unit between the two age groups.

Conclusions

Higher troponin release is seen in infants in comparison with older children after bypass for similar surgeries. A troponin level greater than 100 after bypass does not necessarily predict death or a severe cardiovascular event in the very young.

Keywords

Open heart surgerycongenital cardiac malformationsmyocardial ischaemiapaediatriccongenital heart surgerycyanosis
Type
Original Articles
Information
Cardiology in the Young , Volume 23 , Issue 3 , June 2013 , pp. 431 - 435
Copyright
Copyright © Cambridge University Press 2012 

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References

1. Bhavsar, PK, Dhoot, GK, Cumming, DV, Butler-Browne, GS, Yacoub, MH, Barton, PJ. Developmental expression of troponin I isoforms in fetal human heart. FEBS Lett 1991; 292: 5–8.Google ScholarPubMed
2. Bodor, GS, Porterfield, D, Voss, EM, Smith, S, Apple, FS. Cardiac troponin-I is not expressed in fetal and healthy or diseased adult human skeletal muscle tissue. Clin Chem 1995; 41: 1710–1715.Google Scholar
3. 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: 2073–2077.Google Scholar
4. 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: 250–255.Google Scholar
5. Immer, FF, Stocker, F, Seiler, AM, et al. Troponin-I for prediction of early postoperative course after pediatric cardiac surgery. J Am Coll Cardiol 1999; 33: 1719–1723.Google Scholar
6. Modi, P, Imura, H, Angelini, GD, et al. Pathology-related troponin I release and clinical outcome after pediatric open heart surgery. J Card Surg 2003; 18: 295–300.Google Scholar
7. Hammer, S, Loeff, M, Reichenspurner, H, et al. Effect of cardiopulmonary bypass on myocardial function, damage and inflammation after cardiac surgery in newborns and children. Thorac Cardiovasc Surg 2001; 49: 349–354.Google Scholar
8. Taggart, DP, Hadjinikolas, L, Wong, K, et al. Vulnerability of paediatric myocardium to cardiac surgery. Heart 1996; 76: 214–217.Google Scholar
9. Imura, H, Caputo, M, Parry, A, Pawade, A, Angelini, GD, Suleiman, MS. Age-dependent and hypoxia-related differences in myocardial protection during pediatric open heart surgery. Circulation 2001; 103: 1551–1556.Google Scholar
10. Jenkins, KJ, Gauvreau, K, Newburger, JW, Spray, TL, Moller, JH, Iezzoni, LI. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 2002; 123: 110–118.Google Scholar
11. 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: 620–625.Google Scholar
12. Drinkwater, DC, Laks, H. Pediatric cardioplegic techniques. Semin Thorac Cardiovasc Surg 1993; 5: 168–175.Google Scholar
13. Taggart, DP, Hadjinikolas, L, Hooper, J, et al. Effects of age and ischemic times on biochemical evidence of myocardial injury after pediatric cardiac operations. J Thorac Cardiovasc Surg 1997; 113: 728–735.Google Scholar
14. Lasocki, S, Provenchere, S, Benessiano, J, et al. Cardiac troponin I is an independent predictor of in-hospital death after adult cardiac surgery. Anesthesiology 2002; 97: 405–411.Google Scholar
15. Fellahi, JL, Hedoire, F, Le Manach, Y, Monier, E, Guillou, L, Riou, B. Determination of the threshold of cardiac troponin I associated with an adverse postoperative outcome after cardiac surgery: a comparative study between coronary artery bypass graft, valve surgery, and combined cardiac surgery. Crit Care 2007; 11: R106.Google Scholar
16. Lipshultz, SE, Rifai, N, Sallan, SE, et al. Predictive value of cardiac troponin T in pediatric patients at risk for myocardial injury. Circulation 1997; 96: 2641–2648.Google Scholar
17. Mildh, LH, Pettila, V, Sairanen, HI, Rautiainen, PH. Cardiac troponin T levels for risk stratification in pediatric open heart surgery. Ann Thorac Surg 2006; 82: 1643–1648.Google Scholar
18. 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.Google Scholar
19. Kirklin, JK, Blackstone, EH, Kirklin, JW, McKay, R, Pacifico, AD, Bargeron, LM Jr. Intracardiac surgery in infants under age 3 months: incremental risk factors for hospital mortality. Am J Cardiol 1981; 48: 500–506.Google Scholar
20. Carmona, F, Manso, PH, Vicente, WV, Castro, M, Carlotti, AP. Risk stratification in neonates and infants submitted to cardiac surgery with cardiopulmonary bypass: a multimarker approach combining inflammatory mediators, N-terminal pro-B-type natriuretic peptide and troponin I. Cytokine 2008; 42: 317–324.Google Scholar