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Myocardial Injury Following Aortic Valve Replacement for Severe Aortic Stenosis: Risk Factor of Postoperative Myocardial Injury and Its Impact on Long-Term Outcomes
BACKGROUND: As hypertrophied myocardium predisposes the patient to decreased tolerance to ischemia and increased reperfusion injury, myocardial protection is of utmost importance in patients undergoing aortic valve replacement (AVR) for severe aortic valve stenosis (AS). METHODS: Consecutive 314 pat...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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The Korean Society for Thoracic and Cardiovascular Surgery
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4157473/ https://www.ncbi.nlm.nih.gov/pubmed/25207220 http://dx.doi.org/10.5090/kjtcs.2014.47.3.233 |
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author | Lee, Chee-Hoon Ju, Min Ho Kim, Joon Bum Chung, Cheol Hyun Jung, Sung Ho Choo, Suk Jung Lee, Jae Won |
author_facet | Lee, Chee-Hoon Ju, Min Ho Kim, Joon Bum Chung, Cheol Hyun Jung, Sung Ho Choo, Suk Jung Lee, Jae Won |
author_sort | Lee, Chee-Hoon |
collection | PubMed |
description | BACKGROUND: As hypertrophied myocardium predisposes the patient to decreased tolerance to ischemia and increased reperfusion injury, myocardial protection is of utmost importance in patients undergoing aortic valve replacement (AVR) for severe aortic valve stenosis (AS). METHODS: Consecutive 314 patients (mean age, 62.5±10.8 years; 143 females) with severe AS undergoing isolated AVR were included. Postoperative myocardial injury (PMI) was defined as 1) maximum postoperative creatinine kinase isoenzyme MB or troponin-I levels ≥10 times of reference, 2) postoperative low cardiac output syndrome or episodes of ventricular arrhythmia, or 3) left ventricular ejection fraction of less than 55% and decrease in left ventricle (LV) ejection fraction of more than 20% of the baseline value. RESULTS: There were 90 patients (28.7%) who developed PMI. There were five cases of early death (1.6%), all of whom had PMI. On multivariable analysis, the use of histidine-tryptophan-ketoglutarate (HTK) solution instead of blood cardioplegia (odds ratio [OR], 3.06; 95% confidence interval [CI], 1.63 to 5.77; p=0.001), greater LV mass (OR, 1.04; 95% CI, 1.01 to 1.07; p=0.007), and increased cardiac ischemic time (OR, 1.13; 95% CI, 1.05 to 1.22; p<0.001) were independent predictors for PMI. Patients who had PMI showed significantly inferior long-term survival than those without PMI (p=0.049). CONCLUSION: PMI occurred in a considerable proportion of patients undergoing AVR for severe AS and was associated with poor long-term survival. HTK cardioplegia, higher LV mass, and longer cardiac ischemic duration were suggested as predictors of myocardial injury. |
format | Online Article Text |
id | pubmed-4157473 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | The Korean Society for Thoracic and Cardiovascular Surgery |
record_format | MEDLINE/PubMed |
spelling | pubmed-41574732014-09-09 Myocardial Injury Following Aortic Valve Replacement for Severe Aortic Stenosis: Risk Factor of Postoperative Myocardial Injury and Its Impact on Long-Term Outcomes Lee, Chee-Hoon Ju, Min Ho Kim, Joon Bum Chung, Cheol Hyun Jung, Sung Ho Choo, Suk Jung Lee, Jae Won Korean J Thorac Cardiovasc Surg Clinical Research BACKGROUND: As hypertrophied myocardium predisposes the patient to decreased tolerance to ischemia and increased reperfusion injury, myocardial protection is of utmost importance in patients undergoing aortic valve replacement (AVR) for severe aortic valve stenosis (AS). METHODS: Consecutive 314 patients (mean age, 62.5±10.8 years; 143 females) with severe AS undergoing isolated AVR were included. Postoperative myocardial injury (PMI) was defined as 1) maximum postoperative creatinine kinase isoenzyme MB or troponin-I levels ≥10 times of reference, 2) postoperative low cardiac output syndrome or episodes of ventricular arrhythmia, or 3) left ventricular ejection fraction of less than 55% and decrease in left ventricle (LV) ejection fraction of more than 20% of the baseline value. RESULTS: There were 90 patients (28.7%) who developed PMI. There were five cases of early death (1.6%), all of whom had PMI. On multivariable analysis, the use of histidine-tryptophan-ketoglutarate (HTK) solution instead of blood cardioplegia (odds ratio [OR], 3.06; 95% confidence interval [CI], 1.63 to 5.77; p=0.001), greater LV mass (OR, 1.04; 95% CI, 1.01 to 1.07; p=0.007), and increased cardiac ischemic time (OR, 1.13; 95% CI, 1.05 to 1.22; p<0.001) were independent predictors for PMI. Patients who had PMI showed significantly inferior long-term survival than those without PMI (p=0.049). CONCLUSION: PMI occurred in a considerable proportion of patients undergoing AVR for severe AS and was associated with poor long-term survival. HTK cardioplegia, higher LV mass, and longer cardiac ischemic duration were suggested as predictors of myocardial injury. The Korean Society for Thoracic and Cardiovascular Surgery 2014-06 2014-06-05 /pmc/articles/PMC4157473/ /pubmed/25207220 http://dx.doi.org/10.5090/kjtcs.2014.47.3.233 Text en Copyright © 2014 by The Korean Society for Thoracic and Cardiovascular Surgery. All rights Reserved. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Clinical Research Lee, Chee-Hoon Ju, Min Ho Kim, Joon Bum Chung, Cheol Hyun Jung, Sung Ho Choo, Suk Jung Lee, Jae Won Myocardial Injury Following Aortic Valve Replacement for Severe Aortic Stenosis: Risk Factor of Postoperative Myocardial Injury and Its Impact on Long-Term Outcomes |
title | Myocardial Injury Following Aortic Valve Replacement for Severe Aortic Stenosis: Risk Factor of Postoperative Myocardial Injury and Its Impact on Long-Term Outcomes |
title_full | Myocardial Injury Following Aortic Valve Replacement for Severe Aortic Stenosis: Risk Factor of Postoperative Myocardial Injury and Its Impact on Long-Term Outcomes |
title_fullStr | Myocardial Injury Following Aortic Valve Replacement for Severe Aortic Stenosis: Risk Factor of Postoperative Myocardial Injury and Its Impact on Long-Term Outcomes |
title_full_unstemmed | Myocardial Injury Following Aortic Valve Replacement for Severe Aortic Stenosis: Risk Factor of Postoperative Myocardial Injury and Its Impact on Long-Term Outcomes |
title_short | Myocardial Injury Following Aortic Valve Replacement for Severe Aortic Stenosis: Risk Factor of Postoperative Myocardial Injury and Its Impact on Long-Term Outcomes |
title_sort | myocardial injury following aortic valve replacement for severe aortic stenosis: risk factor of postoperative myocardial injury and its impact on long-term outcomes |
topic | Clinical Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4157473/ https://www.ncbi.nlm.nih.gov/pubmed/25207220 http://dx.doi.org/10.5090/kjtcs.2014.47.3.233 |
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