PMID- 38541817
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240330
IS  - 2077-0383 (Print)
IS  - 2077-0383 (Electronic)
IS  - 2077-0383 (Linking)
VI  - 13
IP  - 6
DP  - 2024 Mar 10
TI  - Risk Factors for Higher Postoperative Myocardial Injury in Minimally Invasive 
      Mitral Valve Surgery Patients: A Cohort Study.
LID - 10.3390/jcm13061591 [doi]
LID - 1591
AB  - Background: Postoperative myocardial injury, as detected by an elevated 
      concentration of high-sensitivity cardiac troponin I (hs-cTnI), is a common 
      complication in cardiac surgery that may be linked to mortality. The primary aim 
      of this study was to assess the risk factors associated with increased myocardial 
      injury in patients undergoing minimally invasive mitral valve surgery. Methods: 
      In this retrospective monocentric cohort study, we analyzed all patients who 
      underwent elective minimally invasive mitral valve surgery between January 2019 
      and December 2022 and were subsequently admitted to our intensive care unit. The 
      study population was divided into two groups based on the peak hs-cTnI level: the 
      "lower myocardial injury" group comprised patients whose peak serum hs-cTnI level 
      was less than 499 times the 99th percentile, while the "higher myocardial injury" 
      group included those patients who exhibited hs-cTnI levels equal to or greater 
      than 500 times the 99th percentile. A multivariable logistic regression analysis 
      was performed to identify independent risk factors associated with higher 
      myocardial injury. Results: In our final analysis, we enrolled 316 patients. 
      Patients with higher myocardial injury (48; 15%) more frequently had a 
      preoperative New York Heart Association (NYHA) class >/=3 compared to those with 
      lower myocardial injury [33 (69%) vs. 128 (48%); p < 0.01-OR 2.41 (95% CI 
      1.24-4.64); p < 0.01]. Furthermore, cardiopulmonary bypass and aortic cross-clamp 
      time were significantly longer in the higher myocardial injury group compared to 
      the lower myocardial injury group [117 (91-145) vs. 86 (74-100) min; p < 0.01-OR 
      1.05 (95% CI 1.03-1.06); p < 0.01]. Moreover, patients who underwent 
      robotic-assisted mitral valve surgery experienced lower myocardial injury rates 
      [9 (19%) vs. 102 (38%); p = 0.01-OR 0.38 (95% CI 0.18-0.81); p = 0.01] than 
      others. These findings remained consistent after adjustment in multivariate 
      logistic regression. In terms of postoperative outcomes, patients with higher 
      myocardial injury exhibited the highest lactate peak in the first 24 h, a higher 
      incidence of postoperative acute kidney injury and a longer duration of 
      mechanical ventilation. Although no patients died in either group, those with 
      higher myocardial injury experienced a longer hospital length of stay. 
      Conclusions: Higher myocardial injury is relatively common after minimally 
      invasive mitral valve surgery. Prolonged aortic cross-clamp duration and higher 
      NYHA class were independently associated with myocardial injury, while 
      robotic-assisted mitral valve surgery was independently associated with lower 
      postoperative myocardial injury.
FAU - Baccanelli, Federica
AU  - Baccanelli F
AD  - Department of Anesthesia and Intensive Care, Humanitas Gavazzeni, Via M. 
      Gavazzeni, 21, 24125 Bergamo, Italy.
FAU - Albano, Giovanni
AU  - Albano G
AD  - Department of Anesthesia and Intensive Care, Humanitas Gavazzeni, Via M. 
      Gavazzeni, 21, 24125 Bergamo, Italy.
FAU - Carrara, Alfonso
AU  - Carrara A
AD  - Department of Anesthesia and Intensive Care, Humanitas Gavazzeni, Via M. 
      Gavazzeni, 21, 24125 Bergamo, Italy.
FAU - Parrinello, Matteo
AU  - Parrinello M
AD  - Department of Anesthesia and Intensive Care, Humanitas Gavazzeni, Via M. 
      Gavazzeni, 21, 24125 Bergamo, Italy.
FAU - Roscitano, Claudio
AU  - Roscitano C
AD  - Department of Anesthesia and Intensive Care, Humanitas Gavazzeni, Via M. 
      Gavazzeni, 21, 24125 Bergamo, Italy.
FAU - Cecconi, Maurizio
AU  - Cecconi M
AD  - Department of Biomedical Sciences, Humanitas University, Via Rita Levi 
      Montalcini, 4, Pieve Emanuele, 20072 Milan, Italy.
AD  - Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, 
      Via Manzoni, 56, Rozzano, 20089 Milan, Italy.
FAU - Gerometta, Piersilvio
AU  - Gerometta P
AD  - Department of Cardiac Surgery, Humanitas Gavazzeni, Via M. Gavazzeni, 21, 24125 
      Bergamo, Italy.
FAU - Graniero, Ascanio
AU  - Graniero A
AD  - Department of Cardiac Surgery, Humanitas Gavazzeni, Via M. Gavazzeni, 21, 24125 
      Bergamo, Italy.
FAU - Agnino, Alfonso
AU  - Agnino A
AD  - Department of Cardiac Surgery, Humanitas Gavazzeni, Via M. Gavazzeni, 21, 24125 
      Bergamo, Italy.
FAU - Peluso, Lorenzo
AU  - Peluso L
AUID- ORCID: 0000-0001-6885-5353
AD  - Department of Anesthesia and Intensive Care, Humanitas Gavazzeni, Via M. 
      Gavazzeni, 21, 24125 Bergamo, Italy.
AD  - Department of Biomedical Sciences, Humanitas University, Via Rita Levi 
      Montalcini, 4, Pieve Emanuele, 20072 Milan, Italy.
LA  - eng
PT  - Journal Article
DEP - 20240310
PL  - Switzerland
TA  - J Clin Med
JT  - Journal of clinical medicine
JID - 101606588
PMC - PMC10971517
OTO - NOTNLM
OT  - cardiac anesthesia
OT  - cardiac surgery
OT  - robotic-assisted mitral valve surgery
OT  - troponin
COIS- The authors declare no conflicts of interest.
EDAT- 2024/03/28 06:45
MHDA- 2024/03/28 06:46
PMCR- 2024/03/10
CRDT- 2024/03/28 01:15
PHST- 2024/01/30 00:00 [received]
PHST- 2024/02/26 00:00 [revised]
PHST- 2024/03/07 00:00 [accepted]
PHST- 2024/03/28 06:46 [medline]
PHST- 2024/03/28 06:45 [pubmed]
PHST- 2024/03/28 01:15 [entrez]
PHST- 2024/03/10 00:00 [pmc-release]
AID - jcm13061591 [pii]
AID - jcm-13-01591 [pii]
AID - 10.3390/jcm13061591 [doi]
PST - epublish
SO  - J Clin Med. 2024 Mar 10;13(6):1591. doi: 10.3390/jcm13061591.