Postoperative Serum Troponin Trends in Infants Undergoing Cardiac Surgery

Semin Thorac Cardiovasc Surg. Summer 2019;31(2):244-251. doi: 10.1053/j.semtcvs.2018.08.010. Epub 2018 Sep 6.

Abstract

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.

Keywords: Biomarker; Cardiac surgery; Congenital heart disease; Infant; Troponin-I.

MeSH terms

  • Biomarkers / blood
  • Cardiac Surgical Procedures / adverse effects*
  • Cardiopulmonary Bypass / adverse effects*
  • Female
  • Heart Defects, Congenital / blood
  • Heart Defects, Congenital / diagnosis
  • Heart Defects, Congenital / surgery*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Postoperative Complications / blood*
  • Postoperative Complications / diagnosis
  • Postoperative Complications / mortality
  • Predictive Value of Tests
  • Prospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Troponin I / blood*
  • Up-Regulation

Substances

  • Biomarkers
  • Troponin I