Published online before print July 21, 2003, doi: 10.1161/01.CIR.0000081779.88132.74
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(Circulation. 2003;108:577.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Effect of Two Different Bypass Techniques on the Serum Troponin-T Levels in Newborns and Children
Does pH-Stat Provide Better Protection?
From the Yorkshire Heart Centre (Z.L.N., T.S., S.M., R.R.G., J.G., K.G.W.) and Department of Chemical Pathology (M.C.), Leeds Teaching Hospitals, Leeds, UK, and Department of Cardiac Surgery (Z.L.N.), University of Debrecen, Hungary.
Correspondence to Kevin G. Watterson, Yorkshire Heart Centre, Leeds Teaching Hospitals, Calverley St, Leeds LS1 3EX, UK. E-mail kevin.watterson{at}leedsth.nhs.uk
Received August 23, 2002; de novo received January 29, 2003; revision received May 12, 2003; accepted May 12, 2003.
Background— Cardiac troponin-T is a sensitive marker of myocardial damage. In a prospective study, the effect of 2 different pH strategies during cardiopulmonary bypass on ischemic myocardial injury and clinical outcome was measured in a pediatric population.
Methods and Results— One hundred one patients (31 neonates 13.2±8.3 days and 70 children 34.5±44.1 months of age) undergoing open-heart surgery were selected to either 
-stat (n=51) or pH-stat (n=50) acid-based management protocol. Serum troponin-T levels were measured before and 30 minutes after bypass and then 4 and 24 hours postoperatively. Surgical procedure, bypass details, inotropic support requirement, and postoperative recovery were recorded. Baseline troponin-T level was higher in neonates than in children (0.18±0.22 versus 0.04±0.05 µg/L, P=0.02). Also, a higher baseline level was found in patients with pulmonary hypertension (0.13±0.21 versus 0.04±0.05 µg/L, P=0.04). Cyanotic children showed a higher peak troponin-T level (3.76±3.11 versus 1.67±1.33 µg/L, P=0.04). Peak troponin levels showed a correlation with the length of circulatory arrest and aortic cross-clamp time. Postoperative levels remained high at 24 hours in patients requiring inotropic support. Peak troponin-T levels were significantly lower in the pH-stat group in patients with pulmonary hypertension (P=0.03) and in cases where circulatory arrest (P=0.01) or inotropic support (P=0.01) was necessary during operation than in those with -stat technique. Postoperative ventilation time and length of intensive care unit stay were also significantly longer with -stat than with pH-stat technique (P=0.005 and P=0.006, respectively).
Conclusions— Cardiac troponin-T sensitively reflects myocardial damage in children. Our results suggest that pH-stat acid-based management protocol may provide better protection against ischemic myocardial damage than -stat technique.
Key Words: pediatrics • cardiopulmonary bypass • myocardium • ischemia
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