title: Troponin I levels in extracorporeal membrane oxygenation following congenital heart surgery.
abstract: BACKGROUND
  Correlating postcardiotomy extracorporeal membrane oxygenation (ECMO) troponin I (TnI) levels and outcomes.
  
  
  METHODS
  Between January 2006 and August 2010, 34 patients needed postcardiotomy ECMO for low cardiac output. Bailout ECMO was required either after unsuccessful weaning from bypass (n = 17, 50%), postoperatively from prolonged hemodynamic failure (n = 8, 23.5%), or following resuscitation (n = 9, 26.5%). The TnI levels were measured following surgery or resuscitation during 10 days and compared between survivors (group I) and non-survivors (group II).
  
  
  RESULTS
  Median support duration was seven days (range: 0-31). Surgery involving hypoplastic aortic arch repair (Norwood palliation; n = 7, 20.6%, or biventricular repair; n = 11, 32.4%) led to most ECMO runs. Successful weaning from ECMO and hospital survival were 76.5% and 50%, respectively. In group I, peak TnI levels were reached by 24 hours postoperatively, comparable to levels in group II (36 ± 34 vs 49 ± 38 ng/mL; P = .98). However, in group II, TnI levels formed a plateau by the second postoperative day, whereas group I showed a steep decline in TnI levels, suggesting myocardial recovery (P = .028). All patients (n = 4) who reached or maintained peak TnI levels at 48 hours died. On days 8, 9 and 10, TnI levels were significantly higher in group II (P = .024, .019, and .013, respectively).
  
  
  CONCLUSIONS
  Postcardiotomy ECMO was most commonly required after aortic arch repair. In the absence of ongoing myocardial insult due to ECMO hardware issues, coronary insufficiency or residual lesions, plateau TnI levels at 48 hours may seem to indicate an unfavorable outcome due to irreversible myocardial damage.
authors.affiliation: Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Erlangen, Germany.
authors.forename: André
authors.initials: A
authors.lastname: Rüffer
authors.forename: Frank
authors.initials: F
authors.lastname: Münch
authors.forename: Sergej
authors.initials: S
authors.lastname: Potapov
authors.forename: Ariawan
authors.initials: A
authors.lastname: Purbojo
authors.forename: Okan
authors.initials: O
authors.lastname: Toka
authors.forename: Ali
authors.initials: A
authors.lastname: Dodge-Khatami
authors.forename: Sven
authors.initials: S
authors.lastname: Dittrich
authors.forename: Robert Anton
authors.initials: RA
authors.lastname: Cesnjevar
mesh_terms: D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood* / Q000601:surgery*; D006343:Heart Septal Defects / Q000097:blood / Q000601:surgery; D006352:Heart Ventricles / Q000002:abnormalities; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000097:blood / Q000601:surgery; D007223:Infant; D008297:Male; D018633:Pulmonary Atresia / Q000097:blood / Q000601:surgery; D014188:Transposition of Great Vessels / Q000097:blood / Q000601:surgery; D019210:Troponin I / Q000097:blood*
chemical_list: D019210:Troponin I
keywords: aortic arch; congenital heart surgery; extracorporeal membrane oxygenation; troponin