Postoperative Cardiac Biomarker Release After Minimally Invasive AV-Valve Surgery with or without Cryoablation.

Area of Science:

• Cardiology
• Cardiac Surgery
• Biomarker Analysis

Background:

• Concomitant cryoablation for atrial fibrillation is common during minimally invasive atrioventricular (AV) valve surgery.
• Established biomarker thresholds for postoperative myocardial infarction (pMI) after coronary artery bypass surgery may not apply to endoscopic valve surgery with cryoablation.

Purpose of the Study:

• To analyze perioperative cardiac biomarker release patterns in patients undergoing endoscopic AV valve surgery with or without cryoablation.
• To evaluate the applicability of Society for Cardiovascular Angiography and Interventions (SCAI)-defined pMI thresholds in this specific patient cohort.

Main Methods:

• Retrospective analysis of patients undergoing endoscopic AV valve surgery between 2018 and 2024.
• Comparison of perioperative creatine kinase-myocardial band (CK-MB) and troponin T (TnT) levels between cryoablation and non-cryoablation groups.
• Assessment of in-hospital outcomes and comparison of biomarker levels against SCAI pMI criteria.

Main Results:

• Cryoablation significantly increased both CK-MB (6.4x ULN) and TnT (257x ULN) compared to the non-cryoablation group (2.4x ULN and 80x ULN, respectively).
• While CK-MB remained below SCAI pMI thresholds, TnT frequently exceeded them (p < 0.05) in the cryoablation group.
• Despite biomarker elevations, clinical pMI rates were low and not significantly different between groups; in-hospital mortality also showed no significant difference.

Conclusions:

• Cryoablation during minimally invasive AV valve surgery leads to substantial increases in postoperative cardiac biomarkers.
• Current SCAI criteria for pMI may overestimate infarction in patients undergoing cryoablation due to elevated TnT levels.
• Development of procedure-specific biomarker thresholds is crucial for accurate diagnosis and management in this patient population.