Postoperative patterns and kinetics of cTnI, cTnT CK-MB-activity and CK-activity after elective aortic valve replacement

Objectives: The aim of this prospective study was to evaluate postoperative kinetics of four different biochemical ischaemic markers after elective ao rtic valve replacement (AVR). Additionally, pre-, peri- and postoperative d ata 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 s erum activities of CK-MB and CK were measured preoperatively as well as 0, 6, 12, 24, 48 and 120 hours after reirioval of the aortic cross-clamp. Clin ical data were assessed in all patients and correlated with postoperative e nzyme patterns. Results: There were no major complications. Preoperatively, all patients sh owed enzyme values in the normal range whereas the four ischaemic markers r eached higher values postoperatively. cTnI reached its maximum values 24 ho urs (X-Med = 2.35 mug/L, 95%-CI [2.0,3.3]) and cTnT 48 hours after the oper ation (X-Med = 0.239 mug/L, 95%-CI [0.174, 0.283]). Typical biphasic releas e kinetics could be demonstrated for cTnT. There was a high linear correlat ion 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 postoperati vely X-Med = 0.5 mu /L, 95%-CI [0.2, 0.6]), whereas cTnT still remained pat hologically, elevated(X-Med = 0.223 mug/L, 95%-CI[0.137, 0.299]). No linear correlation was found between maximum values of the ischaemic markers post operatively and age, gender, body surface area, ejection fraction, LV-hyper trophy, operating time, ECC time, time of cardiac arrest, lowest body, temp erature, perfusion pressure, cardioplegia volume, reperfusion time, postope rative septiformic circulatory instability, or ventilation time. Conclusions: All four ischaemic markers showed individual peak characterist ics 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.