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Risk Factors for Higher Postoperative Myocardial Injury in Minimally Invasive Mitral Valve Surgery Patients: A Cohort
Federica Baccanelli1, Giovanni Albano1, Alfonso Carrara1
1Department of Anesthesia and Intensive Care, Humanitas Gavazzeni, Via M. Gavazzeni, 21, 24125 Bergamo, Italy.
Journal of Clinical Medicine
|March 28, 2024
Summary
Postoperative myocardial injury is common after minimally invasive mitral valve surgery. Prolonged aortic cross-clamp time and higher NYHA class increase risk, while robotic-assisted surgery reduces it.
Area of Science:
- Cardiology
- Cardiac Surgery
- Intensive Care Medicine
Background:
- Postoperative myocardial injury, indicated by elevated high-sensitivity cardiac troponin I (hs-cTnI), is a frequent complication in cardiac surgery.
- This complication is associated with increased mortality.
- Identifying risk factors is crucial for improving patient outcomes.
Purpose of the Study:
- To assess risk factors for elevated myocardial injury after minimally invasive mitral valve surgery.
- To identify predictors of increased hs-cTnI levels in this patient cohort.
Main Methods:
- Retrospective monocentric cohort study of patients undergoing elective minimally invasive mitral valve surgery (January 2019 - December 2022).
- Patients categorized into "lower" (<499x 99th percentile hs-cTnI) and "higher" (≥500x 99th percentile hs-cTnI) myocardial injury groups.
- Multivariable logistic regression analysis to identify independent risk factors.
Main Results:
- Higher myocardial injury (15%) was associated with preoperative NYHA class ≥3 (OR 2.41) and longer cardiopulmonary bypass and aortic cross-clamp times (OR 1.05).
- Robotic-assisted mitral valve surgery was associated with significantly lower myocardial injury rates (OR 0.38).
- Higher myocardial injury correlated with increased lactate peak, acute kidney injury, and longer mechanical ventilation and hospital stay.
Conclusions:
- Elevated myocardial injury is a common occurrence following minimally invasive mitral valve surgery.
- Independent risk factors for myocardial injury include prolonged aortic cross-clamp duration and higher NYHA class.
- Robotic-assisted mitral valve surgery demonstrates an independent association with reduced postoperative myocardial injury.
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