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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...

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Autores principales: Lee, Chee-Hoon, Ju, Min Ho, Kim, Joon Bum, Chung, Cheol Hyun, Jung, Sung Ho, Choo, Suk Jung, Lee, Jae Won
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Society for Thoracic and Cardiovascular Surgery 2014
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.
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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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