CLINICAL STUDIES
Troponin-I for prediction of early postoperative course after pediatric cardiac surgery
Franz F. Immer, MD*,
Franco Stocker, MD ,
Andrea M. Seiler, MD,
Jean-Pierre Pfammatter, MD,
Denis Bachmann, MD ,
Gert Printzen, MD and
Thierry Carrel, MD*
* Department of Cardiovascular Surgery, University Hospital, Berne, Switzerland
Division of Pediatric Cardiology, University Hospital, Berne, Switzerland
Division of Pediatric Intensive Care, University Hospital, Berne, Switzerland
Department of Clinical Chemistry, University Hospital, Berne, Switzerland
Manuscript received August 14, 1998;
revised manuscript received January 6, 1999,
accepted January 21, 1999.
Reprint requests and correspondence: Dr. Franco Stocker, MD, Division of Pediatric Cardiology, University Hospital, 3010 Berne, Switzerland
f.immer{at}bluewin.ch
OBJECTIVES
It was the aim of the study to test the prognostic value of cardiac troponin-I (cTnI) concerning the early postoperative course after pediatric cardiac surgery.
BACKGROUND
Cardiac troponin-I is a very specific and sensitive marker of myocardial damage in adults and children. As perioperative myocardial damage may be a significant factor of postoperative cardiac performance, serial cTnI values were analyzed in children undergoing open heart surgery.
METHODS
Seventy-three children undergoing elective correction of congenital heart disease including atrial and ventricular surgical manipulation were studied. Cardiac troponin-I levels were measured serially and correlated with intra- and postoperative parameters (such as doses and length of inotropic support, renal and hepatic function, duration of intubation). Patients with prolonged postoperative recovery were analyzed with special attention to the cTnI levels.
RESULTS
The cutoff point for the definition of a high and a low risk group of cTnI values was set at 25 µg/liter, 4 h after admission to the intensive care unit (ICU) and at 35 µg/liter considering the maximal value of cTnI in the first 24 h in the ICU. The results showed a highly significant correlation between the need for inotropic support, the severity of renal dysfunction and the duration of intubation in relation to the serum levels of cTnI.
CONCLUSIONS
Cardiac troponin-I serum levels after open heart surgery in children and infants 4 h after admission to the ICU allowed anticipation of the postoperative course and correlated with the incidence of significant postoperative complications.
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Abbreviations and Acronyms
| | AV | = atrioventricular | | CPB | = cardiopulmonary bypass time | | cTnI | = cardiac troponin-I | | ICU | = intensive care unit | | NPV | = negative predictive value | | PPV | = positive predictive value | | VSD | = ventricular septal defect |
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