Abstract
Evaluation of perioperative myocardial injury has the significant prognostic value.
In 2000 European Society of Cardiologists (ESC) and American College of Cardiology (ACC)
proposed to use cardiac troponins (Tp) as the preferable marker of myocardial injury because of
their sensitivity and specificity for heart diseases.
Cardiac TpI (cTpI) was considered to be more specific marker of injury than cTpT.
Every off-pump cardiac surgery is associated with the increasing level of troponins. The main
causes of perioperative myocardial injury include incomplete revascularization, diffuse
atherosclerotic lesion of distal coronary bed, spasm, embolism or thrombosis of intact coronary
arteries or shunts, technical problems associated with anastomosis, inadequate intraoperative
myocardial protection, increased myocardial requirement in oxygen (e.g., in case of left ventricle
hypertrophy) and hemodynamic compromise in postoperative period (e.g., hypotension,
hypertension, tachycardia).
Increased level of troponins after off-pump cardiac surgeries can be considered as the marker of
intraoperative myocardial protection. Moreover, rate of cTpI rise is directly correlated with time
of aortic cross-clamping during off-pump cardiac surgeries in terms of intact coronary arteries.
And conversely, rising of injury markers during coronary artery bypass grafting depends on other
factors (quality of revascularization, technique of cardioplegic technique etc.)
Prognostic value of cTpI after off-pump, on-pump and cardioplegic myocardial revascularization
differs significantly. Increased levels of cTpI (cTpI more than 13 ng/ml) after myocardial
revascularization in terms of cardiopulmonary bypass and cardioplegia was associated with
10-fold rise of risk for in-hospital mortality due to frequent short-term complications, but these
data did not allow to predict the mid-term survival. Increased levels of cTpI and the degree of
myocardial injury after off-pump revascularization did not affect the short-term survival.
However, even slight increasing of cTpI (as opposed to CABG under CPB with cardioplegia) was
associated with low mid-term survival due to revascularization problems (graft insufficiency or
incomplete revascularization).
Myocardial revascularization under CPB without cardioplegia increases the release of myocardial
enzymes in comparison with off-pump myocardial revascularization.
Increased levels of cTpI correlate with frequency of significant postoperative complications after
off-pump surgeries for congenital heart diseases. Chronic cyanosis predisposes to greater
myocardial injury during operation.
Accordingly, evaluation of increased troponin level in peripheral blood always suggest the
myocardial injury, but the myocardial injury does not always suggest the ischemic injury.
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