Perioperative Myocardial Injury after Adult Heart Transplant: Determinants and Prognostic Value |
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| Authors: | Luca Salvatore De Santo Michele Torella Gianpaolo Romano Ciro Maiello Marianna Buonocore Ciro Bancone Alessandro Della Corte Nicola Galdieri Gianantonio Nappi Cristiano Amarelli |
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| Affiliation: | 1Chair of Cardiac Surgery, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy—Casa di Cura Montevergine (AV);2Department of Cardiovascular Surgery and Transplants, V. Monaldi Hospital, Naples, Italy;3Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy;University of Catania, ITALY |
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| Abstract: | MethodsData on 362 consecutive recipients (mean age: 47.8±13.7, 20.2% female, 18.2% diabetics, 22.1% with previous cardiac operations, 27.6% hospitalized, 84.9±29.4 ml/min preoperative glomerular filtration rate) were analyzed using multivariable logistic regression modeling. Target outcomes were determinants of troponin release, early graft failure (EGF), acute kidney injury (AKI) and operative death.ResultsMean cTnI release measured 24 hours after transplant was 10.9±11.6 μg/L. Overall hospital mortality was 10.8%, EGF 10.5%, and AKI was 12.2%. cTnI release>10 μg/L proved an independent predictor of EGF (OR 2.2; 95% CI, 1.06–4.6) and AKI (OR 1.031; 95% CI, 1.001-1.064). EGF, in turn, proved a determinant of hospital mortality. Risk factors for cTnI>10 μg/L release were: status 2B (OR 0.35; 95% CI, 0.18-0.69, protective), duration of the ischemic period (OR 1.006; 95% CI, 1.001-1.011), previous cardiac operation (OR 2.9; 95% CI, 1.67-5.0), and left ventricular hypertrophy (OR 3.3; 95% CI, 1.9-5.6).ConclusionsMyocardial enzyme leakage clearly emerged as an epiphenomenon of more complicated clinical course. The complex interplay between surgical procedure features, graft characteristics and recipient end-organ function highlights cTnI release as a risk marker of graft failure and acute kidney injury. The search for optimal myocardial preservation is still an issue. |
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