Does cardioplegia leave room for postconditioning in paediatric cardiac surgery?

AbstractBackgroundPostconditioning by brief episodes of ischaemia performed just at the time of reperfusion have been shown to reduce the size of infarcts in animal models, and in the clinical setting of percutaneous cardiac intervention. The clinical applicability of postconditioning in cardiac surgery remains to be determined. We investigated the effect of postconditioning on myocardial protection in children undergoing cardiac surgery.MethodsWe randomly assigned 40 patients scheduled for surgical correction of congenitally malformed hearts under cold blood cardioplegic arrest to postconditioning or control treatment. Postconditioning was performed by two cycles of 30 seconds ischaemia and 30 seconds reperfusion using aortic reclamping, and declamping started 30 seconds after cardioplegic arrest. We assayed creatine kinase-MB, troponin I, transcardiac release of lactate and neutrophil counts.ResultsThe types of procedure, age, bypass and aortic cross-clamping times were similar in both groups. The postoperative peaks of creatine kinase-MB and troponin I were lower after aortic de-clamping in the postconditioned patients compared with their controls (128 ± 48 units per liter as opposed to 199 ± 79 units per liter, p = 0.016, and 0.34 ± 0.21 nanograms per milliliter as opposed to 0.61 ± 0.53 nanograms per milliliter, p = 0.05), with reduced inotropic scores in those submitted to postconditioning compared with their controls (4.8 ± 3.1 versus 2.3 ± 1.5, p = 0.036). Transcardiac release of lactate was reduced in the postconditioned patients compared with their controls (0.10 ± 0.27 as opposed to 0.37 ± 0.43 millimols per liter, p = 0.048). No differences between groups were found for transcardiac neutrophil count during reperfusion (10.8 ± 6.3% for postconditioning versus 14.0 ± 8.7% for controls, p = 0.48).ConclusionsOur study demonstrates that postconditioning may protect the myocardium of children undergoing cold blood cardioplegic arrest. These data support the need for a larger clinical trial of postconditiong in children undergoing cardiac surgery.

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A comparison of cardiac post-conditioning and remote pre-conditioning in paediatric cardiac surgery

Cardiology in the Young ◽

10.1017/s1047951110001915 ◽

2011 ◽

Vol 21 (3) ◽

pp. 266-270 ◽

Cited By ~ 24

Author(s):

Wanjun Luo ◽

Ming Zhu ◽

Rimao Huang ◽

Yangde Zhang

Keyword(s):

Creatine Kinase ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Myocardial Protection ◽

Septal Defect ◽

Troponin I ◽

Control Group ◽

Conditioning Group ◽

Cardioplegic Arrest ◽

Creatine Kinase Mb

AbstractBackgroundRemote ischaemic pre-conditioning and cardiac ischaemic post-conditioning provide myocardial protection in cardiac surgery. However, these two endogenous strategies have not been directly compared in a clinical setting. The purpose of this study was to compare the efficacy of remote ischaemic pre-conditioning and post-conditioning in providing myocardial protection to children undergoing cardiopulmonary bypass for surgical repair of ventricular septal defect.MethodsWe randomly assigned 60 paediatric patients scheduled for surgical correction of congenital ventricular septal defect to the post-conditioning group (n = 20), remote pre-conditioning group (n = 20), or control group (n = 20). Post-conditioning consisted of 30 seconds of ischaemia and 30 seconds of reperfusion achieved by clamping and unclamping the aorta, repeated three times over 3 minutes immediately after cardioplegic arrest. Remote ischaemic pre-conditioning consisted of 5 minutes of lower limb ischaemia followed by 5 minutes of reperfusion using a blood-pressure cuff inflated to a pressure of 200 millimetres of mercury, also repeated three times over 30 minutes. We assayed creatine kinase-MB, troponin I.ResultsMean age, cardiopulmonary bypass times, and aortic cross-clamp times were matched across groups. Both post-conditioning and remote ischaemic pre-conditioning reduced the peak release of creatine kinase-MB (86.1 plus or minus 24.1 units per litre and 92.8 plus or minus 20.6 units per litre, respectively, versus 111.0 plus or minus 44.6 units per litre in the control, p less than 0.05) and troponin I (0.28 plus or minus 0.10 nanogram per millilitre and 0.26 plus or minus 0.09 nanogram per millilitre, respectively, versus 0.49 plus or minus 0.19 nanogram per millilitre in the control group, p less than 0.05).ConclusionsOur study demonstrates that ischaemic post-conditioning and remote ischaemic pre-conditioning provide comparable myocardial benefit in children undergoing cold blood cardioplegic arrest.

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Myocardial protection following del Nido cardioplegia in pediatric cardiac surgery

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492318773589 ◽

2018 ◽

Vol 26 (4) ◽

pp. 267-272 ◽

Cited By ~ 3

Author(s):

Debasish Panigrahi ◽

Saibal Roychowdhury ◽

Rahul Guhabiswas ◽

Emmanuel Rupert ◽

Mrinalendu Das ◽

...

Keyword(s):

Intensive Care Unit ◽

Creatine Kinase ◽

Cardiac Surgery ◽

Intensive Care ◽

Cardiopulmonary Bypass ◽

Myocardial Protection ◽

Troponin I ◽

Blood Cardioplegia ◽

Cardioplegia Solution ◽

Creatine Kinase Mb

Background This study was designed to compare myocardial protection with del Nido cardioplegia and conventional blood cardioplegia in children undergoing cardiac surgery in Risk Adjustment for Congenital Heart Surgery categories 1 and 2. Methods Sixty patients were randomized into 2 groups receiving del Nido cardioplegia solution or conventional blood cardioplegia. Myocardial injury was assessed using biochemical markers (troponin I and creatine kinase-MB). Vasoactive-inotropic scores were calculated to compare inotropic requirements. Results Demographic characteristics, cardiopulmonary bypass time, and aortic crossclamp time were comparable in the 2 groups. Time-related changes in troponin I and creatine kinase-MB were similar in both groups. Statistically significant differences were seen in total cardioplegia volume requirement ( p < 0.0001), number of cardioplegia doses given ( p < 0.0001), packed red cell volume usage during cardiopulmonary bypass ( p < 0.02), and time taken to restore spontaneous regular rhythm ( p < 0.0001). Vasoactive-inotropic scores on transfer to the intensive care unit ( p < 0.040) and at 24 h ( p < 0.030) were significantly lower in the del Nido group. Duration of mechanical ventilation, intensive care unit stay, and hospital stay were comparable in the 2 groups. Conclusions Our results show that del Nido cardioplegia solution is as safe as conventional blood cardioplegia. Moreover, it provides the benefits of reduced dose requirement, lower consumption of allogenic blood on cardiopulmonary bypass, quicker resumption of spontaneous regular cardiac rhythm, and less inotropic support requirement on transfer to the intensive care unit and at 24 h, compared to conventional blood cardioplegia.

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Myocardial protection during minimally invasive cardiac surgery through right mini-thoracotomy

Perfusion ◽

10.1177/0267659116679249 ◽

2016 ◽

Vol 32 (3) ◽

pp. 245-252 ◽

Cited By ~ 5

Author(s):

Micaela De Palo ◽

Pietro Guida ◽

Florinda Mastro ◽

Daniela Nanna ◽

Teresa A.P. Quagliara ◽

...

Keyword(s):

Cardiac Surgery ◽

Minimally Invasive ◽

Myocardial Protection ◽

Troponin I ◽

Minimally Invasive Cardiac Surgery ◽

Enzyme Release ◽

Time Duration ◽

Creatine Kinase Mb ◽

Cold Blood ◽

Mini Thoracotomy

Background: Myocardial damage is an independent predictor of adverse outcome following cardiac surgery and myocardial protection is one of the key factors to achieve successful outcomes. Cardioplegia with Custodiol is currently the most used cardioplegia during minimally invasive cardiac surgery (MICS). Different randomized controlled trials compared blood and Custodiol cardioplegia in the context of traditional cardiac surgery. No data are available for MICS. Aim: The aim of this study was to compare the efficacy of cold blood versus Custodiol cardioplegia during MICS. Method: We retrospectively evaluated 90 patients undergoing MICS through a right mini-thoracotomy in a three-year period. Myocardial protection was performed using cold blood (44 patients, CBC group) or Custodiol (46 patients, Custodiol group) cardioplegia, based on surgeon preference and complexity of surgery. Results: The primary outcomes were post-operative cardiac troponin I (cTnI) and creatine kinase MB (CKMB) serum release and the incidence of Low Cardiac Output Syndrome (LCOS). Aortic cross-clamp and cardiopulmonary bypass times were higher in the Custodiol group. No difference was observed in myocardial injury enzyme release (peak cTnI value was 18±46 ng/ml in CBC and 21±37 ng/ml in Custodiol; p=0.245). No differences were observed for mortality, LCOS, atrial or ventricular arrhythmias onset, transfusions, mechanical ventilation time duration, intensive care unit and total hospital stay. Conclusions: Custodiol and cold blood cardioplegic solutions seem to assure similar myocardial protection in patients undergoing cardiac surgery through a right mini-thoracotomy approach.

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Long-Term Prognostic Value of Cardiac Troponin I and T Versus Creatine Kinase-MB Mass After Cardiac Surgery in Low-Risk Patients with Stable Symptoms

The American Journal of Cardiology ◽

10.1016/j.amjcard.2010.04.038 ◽

2010 ◽

Vol 106 (6) ◽

pp. 780-786 ◽

Cited By ~ 9

Author(s):

Kjell Vikenes ◽

Knut S. Andersen ◽

Tor Melberg ◽

Mikael Farstad ◽

Jan Erik Nordrehaug

Keyword(s):

Creatine Kinase ◽

Cardiac Surgery ◽

Cardiac Troponin ◽

Prognostic Value ◽

Troponin I ◽

Cardiac Troponin I ◽

Low Risk ◽

Creatine Kinase Mb ◽

Risk Patients

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Frontal QRS-T angle as a predictive marker for myocardial damage in acute carbon monoxide poisoning

Human & Experimental Toxicology ◽

10.1177/09603271211043477 ◽

2021 ◽

pp. 096032712110434

Author(s):

Yusuf K Tekin ◽

Gülaçan Tekin ◽

Naim Nur ◽

İlhan Korkmaz ◽

Sefa Yurtbay

Keyword(s):

Carbon Monoxide ◽

Creatine Kinase ◽

Cardiac Troponin ◽

Troponin I ◽

Myocardial Damage ◽

Cardiac Troponin I ◽

Arterial Oxygen ◽

Co Poisoning ◽

Arterial Blood ◽

Creatine Kinase Mb

Introduction The present study was undertaken to investigate the prognostic value of the frontal QRS-T angle associated with adverse cardiac outcomes in patients with carbon monoxide (CO) poisoning in early stages in the emergency department. Materials and methods The data of 212 patients with CO poisoning who were admitted to the ED between January 2010 and May 2020 were retrospectively analyzed. The frontal QRS-T angle was obtained from the automatic reports of the EKG device. Results Compared to patients without myocardial damage, among patients with myocardial damage, statistically high creatinine, creatine kinase MB, cardiac troponin I, and frontal QRS-T angle values were found ( p < 0.001 for all parameters), while the saturation of arterial blood pH and arterial oxygen values were found to be lower ( p = 0.002 and p < 0.001, respectively). The frontal QRS-T angle values were correlated with creatine kinase, creatine kinase-MB, cardiac troponin I, and oxygen saturation (SpO2) in arterial blood (r = 0. 232, p = 0.001; r = 0. 253, p = < 0.001; r = 0. 389, p = < 0.001; r = −0. 198, p = 0.004, respectively). The optimum cut-off value of the frontal QRS-T angle was found to be 44.5 (area under the curve: 0.901, 95% confidence interval: 0.814–0.988, sensitivity: 87%, specificity: 84%). Conclusions The frontal QRS-T angle, a simple and inexpensive parameter that can be easily obtained from 12-lead surface electrocardiography, can be used as an early indicator in the detection of myocardial damage in patients with CO poisoning.

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Camrelizumab-related lethal arrhythmias and myasthenic crisis in a patient with metastatic thymoma: a case report

10.21203/rs.3.rs-305090/v1 ◽

2021 ◽

Author(s):

Bo Zhang ◽

Laxman Gyawali ◽

Zengzhang Liu ◽

Huaan Du ◽

Yuehui Yin

Keyword(s):

Creatine Kinase ◽

Troponin I ◽

Malignant Tumors ◽

Checkpoint Inhibitors ◽

Underlying Disease ◽

High Dose ◽

Team Approach ◽

Myasthenic Crisis ◽

Conduction Abnormality ◽

Creatine Kinase Mb

Abstract Immune checkpoint inhibitors (ICIs) have emerged in recent years as a promising treatment option for several malignant tumors. However, ICI therapy has also been associated with various immune-related adverse events (irAEs), especially with pre-existing autoimmune status, which sometimes can be life-threatening. A 68-year-old woman diagnosed with metastatic thymoma was treated with camrelizumab as her initial anti-tumor protocol at a nearby hospital. On 11 days after the first dose of camrelizumab, the patient was admitted to our hospital with symptoms of dyspnea, fatigue, and poor appetite. Workup on admission indicated dramatically elevated transaminase, troponin I, creatine kinase, and creatine kinase MB and a new-onset conduction abnormality on electrocardiography. She had no other underlying disease prior to ICI treatment; therefore, ICI-related myocarditis, myositis and hepatitis were diagnosed, and intravenous methylprednisolone (80mg/day) and other supporting treatments were administered sequentially. Coronary angiography was performed on day 3 of hospitalization, but no abnormality was detected. On the same day, she lapsed into a coma with respiratory muscle failure, which was highly suspected of myasthenic crisis. Therefore, mechanical ventilation and higher dose of methylprednisolone (1 g/day) plus intravenous immunoglobulin (20g/day) were applied immediately. The third artrioventricular block occurred abruptly and an urgent temporary pacemaker was placed. Repeated ventricular tachycardia (VT) occurred, and even multiple antiarrhythmic drugs used in combination failed to alleviate the VT storm. On day 5 of hospitalization, she suffered from ventricular fibrillation and die of cardiac arrest. In conclusion, close follow-up should be conducted after ICI treatment, especially for patients already with or at high risk for autoimmune disorders. Once diagnosed with severe irAEs, prompt high dose of glucocorticoid alone or in combination with other immunomodulators if necessary should be administered. A multidisciplinary team approach is of importance for better management of patients with multiple organs involvement.

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Impact of Antibody Specificity and Calibration Material on the Measure of Agreement between Methods for Cardiac Troponin I

Clinical Chemistry ◽

10.1093/clinchem/45.6.822 ◽

1999 ◽

Vol 45 (6) ◽

pp. 822-828 ◽

Cited By ~ 20

Author(s):

David J Newman ◽

Yemi Olabiran ◽

William D Bedzyk ◽

Suzette Chance ◽

Eileen G Gorman ◽

...

Keyword(s):

Creatine Kinase ◽

Regression Analysis ◽

Cardiac Troponin ◽

Troponin I ◽

Cardiac Troponin I ◽

Antibody Specificity ◽

Serum Pool ◽

Creatine Kinase Mb ◽

Patient Values ◽

Calibration Material

Abstract Background: Available assays for cardiac troponin I (cTnI) yield numerically different results. The aim of this study was to compare patient values obtained from four cTnI immunoassays. Methods: We studied the Stratus® II assay, the Opus® II assay, the Access® assay, and a research-only cTnI heterogeneous immunoassay that uses the Dade Behring aca® plus immunoassay system equipped with two new noncommercial monoclonal antibodies. Because the aca plus cTnI assay is for research only, we first evaluated and analytically validated it for serum and citrated plasma. Initially, each method was calibrated using the method-specific calibrator supplied by each manufacturer; however, the aca plus cTnI assay was calibrated using patient serum pools containing cTnI and selected on the basis of increased creatine kinase MB isoenzyme and with values assigned by use of the Stratus cTnI assay. For method comparisons, individual patient sample cTnI values were determined and compared with the Stratus II assay. Results: Passing and Bablock regression analysis yielded slopes of 1.44 (r = 0.96; n = 72) for the Opus II vs Stratus II assays; 0.07 (r = 0.91; n = 72) for the Access vs Stratus II assays; and 0.90 (r = 0.91, n = 72) for the aca plus vs Stratus II assays. The recalibration of each method with a Stratus II-assigned serum pool improved, but did not entirely eliminate, the slope differences between the different assays (range, 1.00–1.16). The observed scatter in the correlation curves remained. Conclusion: There is a need to further explore the specificities of these assays with respect to the different circulating forms of cTnI.

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Comparable detection of acute myocardial infarction by creatine kinase MB isoenzyme and cardiac troponin I

Clinical Chemistry ◽

10.1093/clinchem/40.7.1291 ◽

1994 ◽

Vol 40 (7) ◽

pp. 1291-1295 ◽

Cited By ~ 197

Author(s):

J E Adams ◽

K B Schechtman ◽

Y Landt ◽

J H Ladenson ◽

A S Jaffe

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Creatine Kinase ◽

Cardiac Troponin ◽

Troponin I ◽

Characteristic Curve ◽

Cardiac Injury ◽

Cardiac Troponin I ◽

Creatine Kinase Mb ◽

Coronary Care

Abstract Although measurement of cardiac troponin I (cTnI) is, in some situations, more specific for detection of cardiac injury than is measurement of the MB isoenzyme of creatine kinase (MBCK), its sensitivity and specificity relative to MBCK for detection of myocardial infarction has not been established. Accordingly, we studied prospectively 199 consecutive patients admitted to the coronary care unit. Values of MBCK and cTnI mass were determined in all samples. Of the 188 patients admitted with a suspicion of acute myocardial ischemia, 89 were diagnosed as having an acute myocardial infarction on the basis of the patterns of MBCK values. Eighty-six of these patients also had increased cTnI (concordance, 96.6%); three did not. Of the patients diagnosed as without infarction, five with unstable angina and symptoms in the day(s) prior to admission had increased cTnI, for a cTnI specificity of 94.9%. Receiver operating characteristic curve analysis indicated that cTnI and MBCK had statistically indistinguishable diagnostic accuracies for the detection of acute myocardial infarction.

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