Effect of cardiopulmonary bypass on myocardial function, damage and inflammation after cardiac surgery in newborns and children.
Postoperative measurement of cardiac troponin I, creatine kinase and procalcitonin reflects myocardial damage and systemic inflammatory response after cardiac surgery with cardiopulmonary bypass in children. Pulse-contour cardiac output technique is a less invasive tool for determining postoperative cardiac function.


OBJECTIVE
The aim of our study was to investigate myocardial lesions and systemic inflammatory response after cardiac surgery with cardiopulmonary bypass in children suffering from congenital heart defects.


METHODS
The elevation of cardiac troponin I (cTnI), creatine kinase (CK) and procalcitonin (PCT) was evaluated in relationship to duration of aortic cross-clamping, incisional trauma and cardiac bypass temperature in 37 paediatric patients. To assess postoperative cardiac function, the cardiac index was measured in 7 children using the PiCCO (pulse contour cardiac output) technique.


RESULTS
CTnI and PCT both peaked on the day of surgery and slowly decreased postoperatively in case of an uncomplicated course. The median values of both parameters differed significantly from the day of surgery until the fourth postoperative day in children with an aortic cross-clamping time (CCT) longer than 80 minutes or after ventriculotomy in comparison to patients with shorter clamping times or atriotomy only. CK values showed similar results, but were less significant than cTnI. A relationship between cTnI, CK or PCT and the body temperature during cardiopulmonary bypass was not found. The cardiac indices (CI) measured by the PiCCO technique in the first 48 hours after surgery showed normal values.


CONCLUSIONS
In summary, perioperative measurement of cTnI, CK and PCT reflects myocardial damage and systemic inflammatory response and allows an improved peri- and postoperative management. PiCCO technique is an excellent, less invasive tool to determine postoperative cardiac function.
Hammer
S
S
Department of Paediatric Cardiology and Intensive Care Medicine, Klinikum Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany. Stefanie.Hammer@kk-g.med.uni-muenchen.de
Loeff
M
M
Reichenspurner
H
H
Daebritz
S
S
Tiete
A
A
Kozlik-Feldmann
R
R
Reichart
B
B
Netz
H
H
D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D002302:Cardiac Output / Q000502:physiology; D002315:Cardiopulmonary Bypass; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006321:Heart / Q000502:physiology*; D006330:Heart Defects, Congenital / Q000097:blood / Q000150:complications* / Q000601:surgery*; D006801:Humans; D007223:Infant; D007229:Infant Welfare; D007231:Infant, Newborn; D007249:Inflammation / Q000097:blood / Q000209:etiology; D008297:Male; D009206:Myocardium / Q000378:metabolism* / Q000473:pathology; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology*; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood; D011674:Pulse; D013525:Surgical Instruments; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D019210:Troponin I; D002116:Calcitonin; D003402:Creatine Kinase; D015740:Calcitonin Gene-Related Peptide