Cardiac troponin I after cardiopulmonary bypass in infants in comparison with older children

• Published in: Cardiology in the young 2013-06, Vol.23 (3), p.431-435
• Main Authors: Gupta-Malhotra, Monesha, Kern, Jeffrey H., Flynn, Patrick A., Schiller, Myles S., Quaegebeur, Jan M., Friedman, Deborah M.
• Format: Article
• Language: English
• Subjects: Biomarkers - blood; Cardiopulmonary Bypass; Child; Child, Preschool; Female; Humans; Infant; Length of Stay - statistics & numerical data; Male; Original Articles; Postoperative Complications; Prospective Studies; Time Factors; Troponin I - blood
• ISSN: 1047-9511; 1467-1107
• DOI: 10.1017/S1047951112001163

At the present time, there is a trend towards performing open heart surgery at a younger age. Myocardium of infants has been thought to be more vulnerable to cardiopulmonary bypass in comparison with adults. For this study, we evaluated the degree of myocardial injury by measurement of cardiac troponin levels in infants in comparison with older children for similar surgeries. Serum was collected before bypass, after bypass, and daily after surgery and serum cardiac troponin I level (micrograms per litre). The demographic data, cardiac diagnoses, types of surgery performed, and peri-operative parameters were collected. Of the 21 children enrolled consecutively, five were infants. Among the 21 patients, four patients had post-operative peak troponin values greater than 100 (three were infants) and all four patients survived and had normal left ventricular systolic function upon discharge echocardiogram. The five infants had peak troponin levels of 222.3, 202, 129, 26.7, and 82.3. The post-operative peak troponin levels were significantly higher in infants (mean 132.5 with a standard deviation of 81.6) than in the older children (mean 40.3 with a standard deviation of 33.4), although there was no significant difference in bypass time, bypass temperature, cross-clamp time, or the length of stay in the intensive care unit between the two age groups. Higher troponin release is seen in infants in comparison with older children after bypass for similar surgeries. A troponin level greater than 100 after bypass does not necessarily predict death or a severe cardiovascular event in the very young.