Troponin-I for prediction of early postoperative course after pediatric cardiac surgery

OBJECTIVES It was the aim of the study to test the prognostic value of card iac troponin-I (cTnI) concerning the early postoperative course after pedia tric cardiac surgery. BACKGROUND Cardiac troponin-I is a very specific and sensitive marker of my ocardial damage in adults and children. As perioperative myocardial damage may be a significant factor of postoperative cardiac performance, serial cT nI 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 wi th intra- and postoperative parameters (such as doses and length of inotrop ic support, renal and hepatic function, duration of intubation). Patients w ith prolonged postoperative recovery were analyzed with special attention t o 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 mu g/liter, 4 h after admission to the intensi ve care unit (ICU) and at 35 mu g/liter considering the maximal value of cT nI in the first 24 h in the ICU. The results showed a highly significant co rrelation between the need for inotropic support, the severity of renal dys function and the duration of intubation in relation to the serum levels of cTnI. CONCLUSIONS Cardiac troponin-I serum levels after open heart surgery in chi ldren and infants 4 h after admission to the ICU allowed anticipation of th e postoperative course and correlated with the incidence of significant pos toperative complications, (C) 1999 by the American College of Cardiology.