Cardiac troponin T levels for risk stratification in pediatric open heart surgery.
BACKGROUND
Cardiac troponin T has been found to be accurate predictor of complications and adverse clinical events after pediatric cardiac surgery. Contrary to adult cardiac surgery, the relationship of troponin T to patient survival after pediatric heart surgery has not been previously studied. The purpose of this study was to determine whether troponin T could predict death after pediatric open cardiac surgery.


METHODS
This was a retrospective cohort study in which data from 1001 consecutive children having cardiac surgery during a 5-year period were studied. Perioperative variables that could influence death at 30 postoperative days were evaluated.


RESULTS
Multivariate analysis, using a forward stepwise logistic regression, showed that troponin T measured on the first postoperative day was a strong independent predictor of death at 30 days. Level of troponin T greater than 5.9 microg/L on the first postoperative day predicted death (odds ratio, 10.7; 95% confidence interval: 5.2 to 22.1) as did admission lactate level greater than 5.2 mmol/L (odds ratio, 22.2; 95% confidence interval: 9.7 to 50.8) No other variable, including postoperative creatine kinase-MB mass concentration, age, diagnosis, surgical procedure, presence of cyanosis, chromosomal anomaly or ventriculotomy, duration of cardiopulmonary bypass, or aortic cross-clamp, had any independent effect on 30-day survival.


CONCLUSIONS
Cardiac troponin T level on the first postoperative day is a powerful independent risk marker of death in pediatric cardiac surgery.
Mildh
Leena H
LH
Department of Anesthesiology and Intensive Care, Hospital for Children and Adolescents, Helsinki, Finland. leena.mildh@hus.fi
Pettilä
Ville
V
Sairanen
Heikki I
HI
Rautiainen
Paula H
PH
D006348:Cardiac Surgical Procedures / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011184:Postoperative Period; D012189:Retrospective Studies; D018570:Risk Assessment; D020107:Troponin T / Q000097:blood*
D020107:Troponin T