Myocardial Injury Following Aortic Valve Replacement for Severe Aortic Stenosis: Risk Factor of Postoperative Myocardial Injury and Its Impact on Long-Term Outcomes
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ÀÌÄ¡ÈÆ(Lee Chee-Hoon) - University of Ulsan College of Medicine Asan Medical Center Department of Thoracic and Cardiovascular Surgery
ÁÖ¹ÎÈ£(Ju Min-Ho) - University of Ulsan College of Medicine Asan Medical Center Department of Thoracic and Cardiovascular Surgery
±èÁعü(Kim Joon-Bum) - University of Ulsan College of Medicine Asan Medical Center Department of Thoracic and Cardiovascular Surgery
Á¤Ã¶Çö(Chung Cheol-Hyun) - University of Ulsan College of Medicine Asan Medical Center Department of Thoracic and Cardiovascular Surgery
Á¤¼ºÈ£(Jung Sung-Ho) - University of Ulsan College of Medicine Asan Medical Center Department of Thoracic and Cardiovascular Surgery
ÁÖ¼®Áß(Choo Suk-Jung) - University of Ulsan College of Medicine Asan Medical Center Department of Thoracic and Cardiovascular Surgery
ÀÌÀç¿ø(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¡¾10.8 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 ¡Ã10 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£¼0.001) 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.
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Myocardial injury, Aortic valve, Surgery
KMID :
0364020140470030233
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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.