title: Predictors of cardiac troponin release after mitral valve surgery.
abstract: OBJECTIVE
  Although cardiac troponin I (cTnI) measurement is used extensively as a marker of perioperative myocardial injury, limited knowledge exists in noncoronary artery bypass graft surgery.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  Single-center intensive care unit.
  
  
  METHODS
  None.
  
  
  METHODS
  One hundred eighty-five consecutive adult patients undergoing mitral valve surgery for predominant mitral regurgitation were enrolled and underwent measurement of cTnI at 24 hours after surgery.
  
  
  RESULTS
  CTnI release after mitral valve surgery was significantly associated with an adverse outcome. The optimal cTnI value for predicting adverse outcomes was 14 ng/mL. Univariate preoperative predictors of cTnI release were prior use of diuretics (p = 0.04) or a rheumatic (p = 0.006), ischemic (p = 0.004), or myxomatous (p = 0.005) etiology to mitral disease, whereas intraoperative variables predictive of cTnI release were cross-clamp time (p = 0.005), cardiopulmonary bypass time (p < 0.001), need for mitral valve replacement (p = 0.024), number of electrical cardioversions (p = 0.03), patent foramen ovale closure (p = 0.03), tricuspid valve repair (p = 0.04), need for epinephrine/norepinephrine (p = 0.004) or intra-aortic balloon pump (p = 0.03) in the operating room; and, finally, the surgeon who performed the surgery (p = 0.014). There were no postoperative predictors of excessive cTnI release. In multivariate analysis, the only predictors of cTnI release were the cardiopulmonary bypass time (odds ratio, 1.42; confidence intervals, 1.019-1.064; p = 0.001) and the infusion of epinephrine/norepinephrine in the operating room (odds ratio, 4.002; confidence intervals, 1.238-12.929; p = 0.02).
  
  
  CONCLUSIONS
  After mitral surgery, the need for epinephrine/norepinephrine perioperatively and the cardiopulmonary bypass time independently predict a cTnI release significantly related to an adverse outcome.
authors.affiliation: Department of Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Monaco
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
authors.forename: Camilla
authors.initials: C
authors.lastname: Biselli
authors.forename: Monica
authors.initials: M
authors.lastname: De Luca
authors.forename: Giovanna
authors.initials: G
authors.lastname: Frau
authors.forename: Elena
authors.initials: E
authors.lastname: Bignami
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
mesh_terms: D000368:Aged; D000758:Anesthesia; D019540:Area Under Curve; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass; D002404:Catheterization; D003422:Critical Care; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000601:surgery; D009206:Myocardium / Q000378:metabolism*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011651:Pulmonary Artery; D012372:ROC Curve; D012307:Risk Factors; D016896:Treatment Outcome; D014336:Troponin / Q000378:metabolism*
chemical_list: D014336:Troponin