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Research Article

Vol. 9 No. 2 (2006)

Troponin-I release after cardiac surgery with different surgical techniques and post-operative neurological outcomes

  • Nozeihan Jan Bappu
  • Panangipalli Venugopal
  • Akhshay Kumar Bisoi
  • Pankaj S Mankad
DOI
https://doi.org/10.26443/mjm.v9i2.658
Submitted
November 8, 2020
Published
2020-12-01

Abstract

Cerebral hypoperfusion during cardiopulmonary bypass surgery has been thought to be a factor in the aetiology of brain damage with evidence of post operative neurological deficits. Cardiacspecific biomarkers such as troponin-I, troponin-T and CK-MB have been used extensively to predict myocardial injury and ischaemia. This prospective study investigateed the level of troponin-I release in both off-pump and CPB-technique CABG surgery, as well as postulated a relationship of troponin release and post-operative neurological outcome. A total of 44 adult patients undergoing coronary artery bypass graft (CABG) were enrolled into either an off-pump or on-pump groups, with 22 patients participating in each. Group A (on-pump) underwent myocardial revascularisation with CPB and cardioplegic arrest, while Group B (off pump) underwent beating heart surgery. The measurement of troponin-I is a 1-step enzyme immunoassay method, with specificity and sensitivity set at 0.4 ug/mL. Neurological assessment was done using the NIH Stroke Scale, and neuropsychologic assessment was assessed on cognitive function using modified Weschler Memory Scale, for which scores were standardized to achieve a composite measure of concentration. A set of statistical analysis was done to correlate troponin-I release with different surgical techniques of CPB and OPCAB. Although each independent technique showed a marked rise of troponin-I from baseline to 6 hours post-operatively, the difference in troponin release was not significant between the 2 groups at specified time intervals (p=0.124). There was however a significant correlation of troponin-I release with the number of grafts used in the surgery, irrespective of the type of grafts or surgical technique. None of the patients in either group showed any neurological or cognitive deficits presenting at day 3 and day 7 post-operatively. The findings of this study demonstrate that there is no significant short-term cognitive or neurological dysfunctions post operatively, as indicated by troponin-I release in assessing the severity of myocardial injury.

References

  1. Kuroda Y, Uchimoto R, Kaieda R, Shinkura R, Shinohara K, Miyamoto S, Oshita S, Takeshita H. Central nervous system complications after cardiac surgery: a comparison between coronary artery bypass grafting and valve surgery. Anesthesia & Analgesia. 1993; 76:222-227.
  2. Millar SM, Alston RP, Andrews PJ, Souter MJ. Cerebral hypoperfusion in immediate postoperative period following coronary artery bypass grafting, heart valve, and abdominal aortic surgery. British Journal of Anaesthesia. 2001; 87:229-236.
  3. Fearn SJ, Pole R, Wesnes K, Faragher EB, Hooper TL, McCollum CN. Cerebral injury during cardiopulmonary bypass: emboli impair memory. Journal of Thoracic & Cardiovascular Surgery. 2001; 121:1150-1160.
  4. Schneider M, Valentine S, Hegde RM, Peacock J, March S, Dobb GJ. The effect of different bypass flow rates and low-dose dopamine on gut mucosal perfusion and outcome in cardiac surgical patients.[erratum appears in Anaesth Intensive Care 1999 Apr;27(2):228]. Anaesthesia & Intensive Care. 1999; 27:13-19.
  5. Taylor KM. Central nervous system effects of cardiopulmonary bypass. Annals of Thoracic Surgery. 1998; 66:Suppl-4.
  6. Stump DA, Rogers AT, Hammon JW, Newman SP. Cerebral emboli and cognitive outcome after cardiac surgery. Journal of Cardiothoracic & Vascular Anesthesia. 1996; 10:113-118.
  7. Furlan AJ, Sila CA, Chimowitz MI, Jones SC. Neurologic complications related to cardiac surgery. Neurologic Clinics. 1992; 10:145-166.
  8. Utley JR. Techniques for avoiding neurologic injury during adult cardiac surgery. Journal of Cardiothoracic & Vascular Anesthesia. 1996; 10:38-43.
  9. Kuroda Y, Uchimoto R, Kaieda R, Shinkura R, Shinohara K, Miyamoto S, Oshita S, Takeshita H. Central nervous system complications after cardiac surgery: a comparison between coronary artery bypass grafting and valve surgery. Anesthesia & Analgesia. 1993; 76:222-227.
  10. Nagurney JT, Heredia O, Sane S, Lewis SC, Chang IK. A comparison of three methods for defining acute myocardical infarction. Academic Emergency Medicine 10(5):534. 2003.
  11. Davis GK, Nimrod M. Cardiac biomarker usage in the West Indies. West Indian Medical Journal. 2003; 52:260-261.
  12. de Lemos JA, Morrow DA. Combining natriuretic peptides and necrosis markers in the assessment of acute coronary syndromes. Reviews in Cardiovascular Medicine. 2003; 4:Suppl-46.
  13. Lewandrowski K, Chen A, Januzzi J. Cardiac markers for myocardial infarction. A brief review. American Journal of Clinical Pathology. 2002; 118:Suppl-9.
  14. Gensini GF, Fusi C, Conti AA, Calamai GC, Montesi GF, Galanti G, Noferi D, Carbonetto F, Palmarini MF, Abbate R, Vaccari M. Cardiac troponin I and Q-wave perioperative myocardial infarction after coronary artery bypass surgery. Critical Care Medicine. 1998; 26:1986-1990.
  15. Barron JT. Cardiac troponin I and non-Q-wave myocardial infarction: how useful is it after coronary artery bypass surgery? Critical Care Medicine. 1998; 26:1936-1937.
  16. Fellahi JL, Gue X, Richomme X, Monier E, Guillou L, Riou B. Short- and long-term prognostic value of postoperative cardiac troponin I concentration in patients undergoing coronary artery bypass grafting. Anesthesiology. 2003; 99:270-274.
  17. Ascione R, Caputo M, Angelini GD. Off-pump Coronary Aretry Bypass Grafting: Not a Flash in the Pan. Annals of Thoracic Surgery. 2003; 75:306-13.
  18. Angelini GD et al. Early and midterm outcome after off-pump and on-pump surgery in BEating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials. Lancet. 2002; 359:1194.
  19. Czerny M et al. Inflammatory response and myocardial injury following coronary artery bypass grafting with or without cardiopulmonary bypass. European Journal of Cardiothoracic Surgery. 2000; 17:737-742.
  20. Ascione R et al. Inflammatory Response After coronary revascularisation with or without cardiopulmonary bypass. Annals of Thoracic Surgery. 2000; 69:1198-204.

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