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Postoperative patterns and kinetics of cTnI, cTnT, CK-MB-activity and CK-activity after elective aortic valve
U T Opfermann1, A A Peivandi, M Dahm
1Department of Cardiothoracic and Vascular Surgery, University Hospital of Mainz, Germany. uli.opfermann@web.de
Insights
This study tracked four cardiac injury markers after aortic valve replacement (AVR). Aortic cross-clamping time did not affect these marker levels, suggesting robust surgical outcomes.
Area of Science:
- Cardiovascular Surgery
- Biochemistry
- Cardiac Biomarkers
Background:
- Elective aortic valve replacement (AVR) is a common cardiac procedure.
- Understanding the release kinetics of biochemical markers post-AVR is crucial for patient monitoring.
- Previous studies have explored various cardiac injury markers, but their behavior after AVR requires specific evaluation.
Purpose of the Study:
- To prospectively evaluate the postoperative kinetics of four biochemical ischemic markers following elective AVR.
- To identify factors influencing the postoperative release of these specific cardiac enzymes.
Main Methods:
- Prospective study including 40 patients undergoing elective AVR.
- Serum concentrations of cardiac troponin I (cTnI), cardiac troponin T (cTnT), and serum activities of creatine kinase-MB (CK-MB) and creatine kinase (CK) were measured at multiple time points (preoperative and up to 120 hours post-operation).
- Clinical data were collected and correlated with postoperative enzyme patterns.
Main Results:
- All four ischemic markers showed elevated postoperative levels, with distinct peak times: cTnI at 24 hours and cTnT at 48 hours.
- A biphasic release pattern was observed for cTnT.
- High linear correlations were found between cTnI and cTnT throughout, and between cTnI, cTnT, and CK-MB activity at 48 hours post-unclamping. No correlation was found between peak marker values and various clinical/procedural factors.
Conclusions:
- The four evaluated ischemic markers exhibit individual peak characteristics and kinetics after uncomplicated AVR.
- Contrary to some previous findings, aortic cross-clamping time did not demonstrate a detectable impact on the postoperative peak patterns of these markers.
Objectives:
The aim of this prospective study was to evaluate postoperative kinetics of four different biochemical ischaemic markers after elective aortic valve replacement (AVR). Additionally, pre-, peri- and postoperative data were analysed in order to identify factors with possible impact on the postoperative release of the selected enzymes.
Design:
Forty patients (14 males, 26 females, aged 70 +/- 11 years; EF = 54 +/- 18% [mean +/- SD]) undergoing elective AVR were prospectively included in this study. For all patients, serum concentrations of cTnI, cTnT, and serum activities of CK-MB and CK were measured preoperatively as well as 0, 6, 12, 24, 48 and 120 hours after removal of the aortic cross-clamp. Clinical data were assessed in all patients and correlated with postoperative enzyme patterns.
Results:
There were no major complications. Preoperatively, all patients showed enzyme values in the normal range whereas the four ischaemic markers reached higher values postoperatively. cTnI reached its maximum values 24 hours (XMed = 2.35 micrograms/L, 95%-CI [2.0, 3.3]) and cTnT 48 hours after the operation (XMed = 0.239 microgram/L, 95%-CI [0.174, 0.283]). Typical biphasic release kinetics could be demonstrated for cTnT. There was a high linear correlation between cTnI and cTnT at all sampling times. In contrast, a high linear correlation between cTnI, cTnT, and CK-MB-activity was only found 48 hours after aortic unclamping. cTnI nearly was in normal range 120 h postoperatively (XMed = 0.5 microgram/L, 95%-CI [0.2, 0.6]), whereas cTnT still remained pathologically elevated (XMed = 0.223 microgram/L, 95%-CI [0.137, 0.299]). No linear correlation was found between maximum values of the ischaemic markers postoperatively and age, gender, body surface area, ejection fraction, LV-hypertrophy, operating time, ECC time, time of cardiac arrest, lowest body temperature, perfusion pressure, cardioplegia volume, reperfusion time, postoperative septiformic circulatory instability, or ventilation time.
Conclusions:
All four ischaemic markers showed individual peak characteristics and kinetics after uncomplicated AVR. In contrast to previous findings, aortic cross-clamping time had no detectable impact on postoperative peak patterns of any ischaemic marker.