Korean J Thorac Cardiovasc Surg.  2014 Jun;47(3):233-239.

Myocardial Injury Following Aortic Valve Replacement for Severe Aortic Stenosis: Risk Factor of Postoperative Myocardial Injury and Its Impact on Long-Term Outcomes

• Lee CH
• Ju MH
• Kim JB
• Chung CH
• Jung SH
• Choo SJ
• Lee JW

Abstract

BACKGROUND
As hypertrophied myocardium predisposes the patient to decreased tolerance to ischemia and increased reperfusion injury, myocardial protection is of utmost importance in patients undergoing aortic valve replacement (AVR) for severe aortic valve stenosis (AS).
METHODS
Consecutive 314 patients (mean age, 62.5+/-10.8 years; 143 females) with severe AS undergoing isolated AVR were included. Postoperative myocardial injury (PMI) was defined as 1) maximum postoperative creatinine kinase isoenzyme MB or troponin-I levels > or =10 times of reference, 2) postoperative low cardiac output syndrome or episodes of ventricular arrhythmia, or 3) left ventricular ejection fraction of less than 55% and decrease in left ventricle (LV) ejection fraction of more than 20% of the baseline value.
RESULTS
There were 90 patients (28.7%) who developed PMI. There were five cases of early death (1.6%), all of whom had PMI. On multivariable analysis, the use of histidine-tryptophan-ketoglutarate (HTK) solution instead of blood cardioplegia (odds ratio [OR], 3.06; 95% confidence interval [CI], 1.63 to 5.77; p=0.001), greater LV mass (OR, 1.04; 95% CI, 1.01 to 1.07; p=0.007), and increased cardiac ischemic time (OR, 1.13; 95% CI, 1.05 to 1.22; p<0.001) were independent predictors for PMI. Patients who had PMI showed significantly inferior long-term survival than those without PMI (p=0.049).
CONCLUSION
PMI occurred in a considerable proportion of patients undergoing AVR for severe AS and was associated with poor long-term survival. HTK cardioplegia, higher LV mass, and longer cardiac ischemic duration were suggested as predictors of myocardial injury.

Keyword

Myocardial injury; Aortic valve; Surgery

MeSH Terms

Aortic Valve Stenosis*
Aortic Valve*
Arrhythmias, Cardiac
Cardiac Output, Low
Creatinine
Heart Arrest, Induced
Heart Ventricles
Humans
Ischemia
Myocardial Reperfusion Injury
Myocardium
Phosphotransferases
Risk Factors*
Stroke Volume
Troponin I
Creatinine
Phosphotransferases
Troponin I