Subscribe to RSS
DOI: 10.1055/s-2001-19011
© Georg Thieme Verlag Stuttgart · New York
Effect of Cardiopulmonary Bypass on Myocardial Function,
Damage and Inflammation after Cardiac Surgery in Newborns
and Children
Publication History
Publication Date:
17 December 2001 (online)
![](https://www.thieme-connect.de/media/thoracic/200106/lookinside/thumbnails/10.1055-s-2001-19011-1.jpg)
Postoperative measurement of cardiac troponin I, creatine kinase and procalcitonin reflects myocardial damage and systemic inflammatory response after cardiac surgery with cardiopulmonary bypass in children. Pulse-contour cardiac output technique is a less invasive tool for determining postoperative cardiac function. Objective: The aim of our study was to investigate myocardial lesions and systemic inflammatory response after cardiac surgery with cardiopulmonary bypass in children suffering from congenital heart defects. Methods: The elevation of cardiac troponin I (cTnI), creatine kinase (CK) and procalcitonin (PCT) was evaluated in relationship to duration of aortic cross-clamping, incisional trauma and cardiac bypass temperature in 37 paediatric patients. To assess postoperative cardiac function, the cardiac index was measured in 7 children using the PiCCO (pulse contour cardiac output) technique. Results: CTnI and PCT both peaked on the day of surgery and slowly decreased postoperatively in case of an uncomplicated course. The median values of both parameters differed significantly from the day of surgery until the fourth postoperative day in children with an aortic cross-clamping time (CCT) longer than 80 minutes or after ventriculotomy in comparison to patients with shorter clamping times or atriotomy only. CK values showed similar results, but were less significant than cTnI. A relationship between cTnI, CK or PCT and the body temperature during cardiopulmonary bypass was not found. The cardiac indices (CI) measured by the PiCCO technique in the first 48 hours after surgery showed normal values. Conclusion: In summary, perioperative measurement of cTnI, CK and PCT reflects myocardial damage and systemic inflammatory response and allows an improved peri- and postoperative management. PiCCO technique is an excellent, less invasive tool to determine postoperative cardiac function.
Key words:
Cardiac troponin I - Procalcitonin - Aortic cross-clamping time - Cardiac bypass temperature - Incisional injury
References
- 1 Taggart D P, Hjadjinikolas L, Wong K, Yap J, Hooper J, Kemp M. Vulnerability of pediatric myocardium to cardiac surgery. Heart. 1996; 76 214-217
- 2 Farah C S, Reinach F C. The troponin complex and regulation of muscle contraction. FASEB J. 1995; 9 755-767
- 3 Adams J E, Sicard G A, Allen B T. Diagnosis of perioperative myocardial infarction with measurement of cardiac troponin I. N Engl J Med. 1994; 330 670-674
- 4 Cremer J, Martin M, Redl H. Systemic inflammatory response after cardiopulmonary bypass. Ann Thorac Surg. 1996; 61 1714-1720
- 5 Verkkala K, Valtonen V, Järvinen A, Tolppanen E M. Fever, leucocytosis and C-reactive protein after open-heart surgery and their value in the diagnosis of postoperative infections. Thorac Cardiac Surg. 1987; 35 78-82
- 6 Aouifi A, Piriou V, Blanc P, Bouvier H, Bastien O, Chiari P, Rousson R, Evans R, Lehot J J. Effect of cardiopulmonary bypass on serum Procalcitonin and C-reactive protein concentrations. Br J Anaesth. 1999; 83 602-607
- 7 Alyanakian M A, Dehoux M, Chatel D, Seguret C, Desmonts J M, Durand G, Philip I. Cardiac troponin I in diagnosis of perioperative myocardial infarction after cardiac surgery. J Cardiothorac Vasc Anesth. 1998; 12 288-294
- 8 Truccone N J, Spontnitz H M, Gersony W M, Dell R, Bowman F O, Malm J. Cardiac output in infants and children after open-heart surgery. J Thoracic Cardiovasc Surg. 1976; 71 410-14
- 9 Alfieri O, Agosti J, Subramanian S. Thermodilution cardiac output measurement in infants and small children following intracardiac surgery. J Ped Surg. 1975; 10 649-656
- 10 Hirsch R, Dent C, Wood M Huddleston C, Mendeloff E, Balzer D, Landt Y, Parvin C, Landt M, Ladenson J, Canter C. Patterns and potential value of cardiac Troponin I elevations after pediatric cardiac operations. Ann Thorac Surg. 1998; 65 1394-1399
- 11 Immer F, Stocker F, Seiler A, Pfammatter J P, Printzen G, Carrel T. Comparison of Troponin I and Troponin T after pediatric cardiovascular operation. Ann Thorac Surg. 1998; 66 2073-2077
- 12 Montgomery V L, Sullivan J E, Buchino J J. Prognostic value of pre- and postoperative cardiac troponin I measurement in children having cardiac surgery. Pediatr. Dev Pathol. 2000; 3 53-60
- 13 Taggart D P, Hadjinikolas L, Hooper J, Albert J, Kemp M, Hue D, Yacoub M, Lincoln J C. Effect of age and ischaemic times on biochemical evidence of myocardial injury after pediatric cardiac operations. J Thor Cardiovasc Surg. 1997; 113 728-735
- 14 Sadony V, Körber M, Albes G, Podtschaske V, Etgen T, Trösken T, Ravens U, Scheulen M E. Cardiac Troponin I plasma levels for diagnosis and quantitation of perioperative myocardial damage in patients undergoing coronary artery bypass surgery. Eur J Cardiothor Surg. 1998; 13 57-65
- 15 Hennein H A, Ebba H, Rodriguez J R. Relationship of the proinflammatory cytokines to myocardial ischaemia and dysfunction after uncomplicated coronary revascularization. J Thorac Cardiovasc Surg. 1994; 108 626-635
- 16 Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohoun C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet. 1993; 341 515-518
- 17 Aouifi A, Piriou V, Bastien O, Blanc P, Bouvier H, Evans R, Célard M, Vandenesch F, Rousson R, Lehot J J. Usefulness of procalcitonin for diagnosis of infection in cardiac surgical patients. Crit Care Med. 2000; 28 3171-3176
- 18 Kilger E, Pichler B, Goetz A E, Rank N, Welte M, Mörstedt K, Vetter H O, Gödje O, Schmitz C, Lamm P, Engelschalk E, Muehlbeyer D, Frey L. Procalcitonin as a marker of systemic inflammation after conventional or minimally invasive coronary artery bypass grafting. Thorac Cardiovasc Surgeon. 1998; 46 130-133
- 19 Martinez-Pellus A E, Marino P, Bru M. Can selective digestive decontamination avoid the endotoxinemia and cytokine activation promoted by cardiopulmonary bypass?. Crit Care Med. 1993; 21 1684-1691
- 20 Silomon M, Bach F, Ecker D, Graeter T, Grundmann U, Larsen R. Procalcitonin following cardiopulmonary bypass. Origin from hepatosplanchnicus? Anaesthesist. 1999; 48 395-398
- 21 Adamik B, Kübler-Kielb J, Golebiowska B, Gamian A, Kübler A. Effect of sepsis and cardiac surgery with cardiopulmonary bypass on plasma level of nitric oxide metabolites, neopterin, and procalcitonin: correlation with mortality and postoperative complications. Intensive Care Med. 2000; 26 1259-1267
- 22 Bitkover C Y, Hansson L O, Valen G, Vaage J. Effects of cardiac surgery on some clinically used inflammation markers and procalcitonin. Scand Cardiovasc J. 2000; 34 307-314
Dr. Stefanie Hammer
Department of Pediatric Cardiology
and Intensive Care Medicine
Klinikum Grosshadern
Marchioninistraße 15
81377 Munich
Germany
Phone: 089/7095-2493
Fax: 089/7095-2495
Email: Stefanie.Hammer@kk-g.med.uni-muenchen.de