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- Title
116-I EARLY RISE IN TROPONIN-I PREDICTS LEFT VENTRICULAR DYSFUNCTION IN SIMPLE TRANSPOSITION: A STUDY OF 225 ARTERIAL SWITCH OPERATIONS.
- Authors
Bernier, P.; Hayes, D.; Krishnamurthy, G.; Chen, J.; Quaegebeur, J.; Bacha, E.
- Abstract
Objectives: Prior studies suggest that an elevated troponin I level predicts poor outcomes after the arterial switch operation (ASO) for transposition of the great arteries (TGA). However, no absolute threshold leading to poor outcomes has been convincingly established. This study sought to evaluate the utility of routine troponin measurements in predicting left ventricular (LV) dysfunction after ASO.Methods: Data on 225 consecutive patients undergoing an ASO were analysed. Patients were grouped according to anatomical variations: simple TGA (STGA) (88) and TGA with ventricular septal defect and/or anomalous coronary arteries (137). LV function as determined at discharge by echocardiogram was compared against troponin levels and patterns of troponin rise. Receiver-operating curves were also used to delineate this relationship.Results: Preoperative patient characteristics were similar between anatomical subgroups (Table 1). Baseline troponin levels were higher in patients who underwent a VSD closure. A rise in troponin from baseline at ICU admission was associated with at least mild left ventricular dysfunction at the time of hospital discharge in STGA patients (P < 0.01) and patients with an intact ventricular septum (P < 0.01). LV dysfunction in STGA was predicted with 100% accuracy by a rising troponin level (Fig. 1). The area under the receiver-operating curve was 0.91 when predicting LV dysfunction in patients with an intact ventricular septum.Table 1:Demogaphic and anatomical characteristicsCharacteristic n (%) or mean ± SDSTGA (n = 88)ACA (n = 49)VSD (n = 52)ACA & VSD (n = 36)Total (n = 225)Female20 (23)18 (36)15 (29)12 (33)65 (29)Prenatal diagnosis33 (38)21 (43)23 (44)15 (42)92 (41)Premature (<38 week gestation)19 (22)9 (18)13 (25)7 (19)48 (21)Age at surgery (days)5.8 ± 295.5 ± 168.4 ± 1156.3 ± 425.8 ± 31Birth weight2.9 ± 0.673.3 ± 0.522.9 ± 0.593.4 ± 0.703.1 ± 0.63Weight at surgery3.2 ± 0.633.4 ± 0.593.4 ± 1.83.4 ± 0.713.4 ± 1.0VSD––52 (100)36 (100)88 (39)Coronary configuration*1LCx-2R88 (100)–52 (100)–136 (60)1L-2RCx–23 (47)–12 (33)35 (16)2RLCx–6 (12)–7 (19)13 (6)1LR-2Cx–3 (6)–2 (6)5 (2)1R-2LCx–2 (4)–6 (17)8 (4)Other–12 (24)–16 (44)28 (12)Conclusion: A troponin level that rises to a peak after ICU admission accurately predicts left ventricular dysfunction at discharge in patients with simple TGA and those with an intact ventricular septum. When a VSD closure is performed concomitantly, a postoperative rise in troponin has no significant predictive value.
- Publication
Interactive Cardiovascular & Thoracic Surgery, 2014, Vol 19, Issue suppl_1, pS36
- ISSN
1569-9293
- Publication type
Article
- DOI
10.1093/icvts/ivu276.116