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

대한흉부외과학회지 2014년 47권 3호 p.233 ~ p.239

이치훈(Lee Chee-Hoon) - University of Ulsan College of Medicine Asan Medical Center Department of Thoracic and Cardiovascular Surgery
주민호(Ju Min-Ho) - University of Ulsan College of Medicine Asan Medical Center Department of Thoracic and Cardiovascular Surgery
김준범(Kim Joon-Bum) - University of Ulsan College of Medicine Asan Medical Center Department of Thoracic and Cardiovascular Surgery
정철현(Chung Cheol-Hyun) - University of Ulsan College of Medicine Asan Medical Center Department of Thoracic and Cardiovascular Surgery
정성호(Jung Sung-Ho) - University of Ulsan College of Medicine Asan Medical Center Department of Thoracic and Cardiovascular Surgery
주석중(Choo Suk-Jung) - University of Ulsan College of Medicine Asan Medical Center Department of Thoracic and Cardiovascular Surgery
이재원(Lee Jae-Won) - University of Ulsan College of Medicine Asan Medical Center Department of Thoracic and Cardiovascular Surgery

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 ≥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.

키워드

Myocardial injury, Aortic valve, Surgery
원문 및 링크아웃 정보
등재저널 정보
학술진흥재단(KCI) KoreaMed 대한의학회 회원 
주제코드
주제명(Target field)
연구대상(Population)
연구참여(Sample size)
대상성별(Gender)
질병특성(Condition Category)
연구환경(Setting)
연구설계(Study Design)
연구기간(Period)
중재방법(Intervention Type)
중재명칭(Intervention Name)
키워드(Keyword)
유효성결과(Recomendation)
PMI occurred in a considerable proportion of patients undergoing AVR for severe AS and was associated with poor long-term survival; There were 90 patients (28.7%) who developed PMI. There were five cases of early death (1.6%), all of whom had PMI.
연구비지원(Fund Source)
근거수준평가(Evidence Hierarchy)
출판년도(Year)
참여저자수(Authors)
대표저자
DOI
KCD코드
ICD 03
건강보험코드