Effect of two different bypass techniques on the serum troponin-T levels in newborns and children: does pH-Stat provide better protection?
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. One hundred one patients (31 neonates 13.2+/-8.3 day...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2003-08, Vol.108 (5), p.577-582 |
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| creator | Nagy, Zsolt L Collins, Mike Sharpe, Tracy Mirsadraee, Saeed Guerrero, Rafael R Gibbs, John Watterson, Kevin G |
| description | 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.
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 alpha-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 microg/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 microg/L, P=0.04). Cyanotic children showed a higher peak troponin-T level (3.76+/-3.11 versus 1.67+/-1.33 microg/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 alpha-stat technique. Postoperative ventilation time and length of intensive care unit stay were also significantly longer with alpha-stat than with pH-stat technique (P=0.005 and P=0.006, respectively).
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 alpha-stat technique. |
| doi_str_mv | 10.1161/01.CIR.0000081779.88132.74 |
| format | Article |
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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 alpha-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 microg/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 microg/L, P=0.04). Cyanotic children showed a higher peak troponin-T level (3.76+/-3.11 versus 1.67+/-1.33 microg/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 alpha-stat technique. Postoperative ventilation time and length of intensive care unit stay were also significantly longer with alpha-stat than with pH-stat technique (P=0.005 and P=0.006, respectively).
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 alpha-stat technique.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/01.CIR.0000081779.88132.74</identifier><identifier>PMID: 12874184</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>United States: American Heart Association, Inc</publisher><subject>Acid-Base Equilibrium ; Biomarkers - blood ; Cardiac Pacing, Artificial ; Cardiopulmonary Bypass - adverse effects ; Cardiopulmonary Bypass - methods ; Cardiopulmonary Bypass - mortality ; Child ; Child, Preschool ; Female ; Heart Arrest, Induced - methods ; Heart Defects, Congenital - surgery ; Hospital Mortality ; Humans ; Hydrogen-Ion Concentration ; Infant ; Infant, Newborn ; Length of Stay ; Male ; Multivariate Analysis ; Myocardial Ischemia - etiology ; Myocardial Ischemia - prevention & control ; Myocardium - metabolism ; Prospective Studies ; Reperfusion Injury - etiology ; Reperfusion Injury - prevention & control ; Treatment Outcome ; Troponin T - blood</subject><ispartof>Circulation (New York, N.Y.), 2003-08, Vol.108 (5), p.577-582</ispartof><rights>Copyright American Heart Association, Inc. Aug 5 2003</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c326t-8600e856ef5c0819a83a4f8006bd58d71554b1c897554c4793ce3b41f9ca16913</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12874184$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nagy, Zsolt L</creatorcontrib><creatorcontrib>Collins, Mike</creatorcontrib><creatorcontrib>Sharpe, Tracy</creatorcontrib><creatorcontrib>Mirsadraee, Saeed</creatorcontrib><creatorcontrib>Guerrero, Rafael R</creatorcontrib><creatorcontrib>Gibbs, John</creatorcontrib><creatorcontrib>Watterson, Kevin G</creatorcontrib><title>Effect of two different bypass techniques on the serum troponin-T levels in newborns and children: does pH-Stat provide better protection?</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>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.
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 alpha-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 microg/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 microg/L, P=0.04). Cyanotic children showed a higher peak troponin-T level (3.76+/-3.11 versus 1.67+/-1.33 microg/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 alpha-stat technique. Postoperative ventilation time and length of intensive care unit stay were also significantly longer with alpha-stat than with pH-stat technique (P=0.005 and P=0.006, respectively).
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 alpha-stat technique.</description><subject>Acid-Base Equilibrium</subject><subject>Biomarkers - blood</subject><subject>Cardiac Pacing, Artificial</subject><subject>Cardiopulmonary Bypass - adverse effects</subject><subject>Cardiopulmonary Bypass - methods</subject><subject>Cardiopulmonary Bypass - mortality</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Female</subject><subject>Heart Arrest, Induced - methods</subject><subject>Heart Defects, Congenital - surgery</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Hydrogen-Ion Concentration</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Multivariate Analysis</subject><subject>Myocardial Ischemia - etiology</subject><subject>Myocardial Ischemia - prevention & control</subject><subject>Myocardium - metabolism</subject><subject>Prospective Studies</subject><subject>Reperfusion Injury - etiology</subject><subject>Reperfusion Injury - prevention & control</subject><subject>Treatment Outcome</subject><subject>Troponin T - blood</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdUU1r3DAUFKWl2aT9C0Xk0JtdP31Yci6lLGkSCBTa9Cxk-Zl18EquJCfkL-RXV9ssBKqLNGjmzRuGkHNoaoAWvjRQb29-1s3haFCqq7UGzmol3pANSCYqIXn3lmzKf1cpztgJOU3pvsCWK_menADTSoAWG_J8OY7oMg0jzY-BDlOBEX2m_dNiU6IZ3c5Pf1ZMNHiad0gTxnVPcwxL8JOv7uiMDzgnOnnq8bEP0Sdq_UDdbpqHMuqCDqGol-vqV7aZLjE8TAPSHnPGeIDFIk_Bf_1A3o12TvjxeJ-R398v77bX1e2Pq5vtt9vKcdbmSrdNg1q2OEpX4ndWcytGXbL1g9SDAilFD053qjycUB13yHsBY-cstB3wM_L5ZW7xPgTLZj8lh_NsPYY1GcUl10zxQjz_j3gf1ujLboYBa1ULjS6kixeSiyGliKNZ4rS38clAYw51mQZMqcu81mX-1WWUKOJPR4e13-PwKj32w_8CF06R4g</recordid><startdate>20030805</startdate><enddate>20030805</enddate><creator>Nagy, Zsolt L</creator><creator>Collins, Mike</creator><creator>Sharpe, Tracy</creator><creator>Mirsadraee, Saeed</creator><creator>Guerrero, Rafael R</creator><creator>Gibbs, John</creator><creator>Watterson, Kevin G</creator><general>American Heart Association, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>20030805</creationdate><title>Effect of two different bypass techniques on the serum troponin-T levels in newborns and children: does pH-Stat provide better protection?</title><author>Nagy, Zsolt L ; Collins, Mike ; Sharpe, Tracy ; Mirsadraee, Saeed ; Guerrero, Rafael R ; Gibbs, John ; Watterson, Kevin G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c326t-8600e856ef5c0819a83a4f8006bd58d71554b1c897554c4793ce3b41f9ca16913</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Acid-Base Equilibrium</topic><topic>Biomarkers - blood</topic><topic>Cardiac Pacing, Artificial</topic><topic>Cardiopulmonary Bypass - adverse effects</topic><topic>Cardiopulmonary Bypass - methods</topic><topic>Cardiopulmonary Bypass - mortality</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Female</topic><topic>Heart Arrest, Induced - methods</topic><topic>Heart Defects, Congenital - surgery</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Hydrogen-Ion Concentration</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Multivariate Analysis</topic><topic>Myocardial Ischemia - etiology</topic><topic>Myocardial Ischemia - prevention & control</topic><topic>Myocardium - metabolism</topic><topic>Prospective Studies</topic><topic>Reperfusion Injury - etiology</topic><topic>Reperfusion Injury - prevention & control</topic><topic>Treatment Outcome</topic><topic>Troponin T - blood</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nagy, Zsolt L</creatorcontrib><creatorcontrib>Collins, Mike</creatorcontrib><creatorcontrib>Sharpe, Tracy</creatorcontrib><creatorcontrib>Mirsadraee, Saeed</creatorcontrib><creatorcontrib>Guerrero, Rafael R</creatorcontrib><creatorcontrib>Gibbs, John</creatorcontrib><creatorcontrib>Watterson, Kevin G</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nagy, Zsolt L</au><au>Collins, Mike</au><au>Sharpe, Tracy</au><au>Mirsadraee, Saeed</au><au>Guerrero, Rafael R</au><au>Gibbs, John</au><au>Watterson, Kevin G</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of two different bypass techniques on the serum troponin-T levels in newborns and children: does pH-Stat provide better protection?</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2003-08-05</date><risdate>2003</risdate><volume>108</volume><issue>5</issue><spage>577</spage><epage>582</epage><pages>577-582</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>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.
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 alpha-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 microg/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 microg/L, P=0.04). Cyanotic children showed a higher peak troponin-T level (3.76+/-3.11 versus 1.67+/-1.33 microg/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 alpha-stat technique. Postoperative ventilation time and length of intensive care unit stay were also significantly longer with alpha-stat than with pH-stat technique (P=0.005 and P=0.006, respectively).
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 alpha-stat technique.</abstract><cop>United States</cop><pub>American Heart Association, Inc</pub><pmid>12874184</pmid><doi>10.1161/01.CIR.0000081779.88132.74</doi><tpages>6</tpages></addata></record> |
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| ispartof | Circulation (New York, N.Y.), 2003-08, Vol.108 (5), p.577-582 |
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| source | Journals@Ovid Ovid Autoload; MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Acid-Base Equilibrium Biomarkers - blood Cardiac Pacing, Artificial Cardiopulmonary Bypass - adverse effects Cardiopulmonary Bypass - methods Cardiopulmonary Bypass - mortality Child Child, Preschool Female Heart Arrest, Induced - methods Heart Defects, Congenital - surgery Hospital Mortality Humans Hydrogen-Ion Concentration Infant Infant, Newborn Length of Stay Male Multivariate Analysis Myocardial Ischemia - etiology Myocardial Ischemia - prevention & control Myocardium - metabolism Prospective Studies Reperfusion Injury - etiology Reperfusion Injury - prevention & control Treatment Outcome Troponin T - blood |
| title | Effect of two different bypass techniques on the serum troponin-T levels in newborns and children: does pH-Stat provide better protection? |
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