Troponin-I release after cardiac surgery with different surgical techniques and post-operative neurological outcomes

Abstract

Cerebral hypoperfusion during cardiopulmonary bypass surgery has been thought to be a factor in the aetiology of brain damage with evidence of post operative neurological deficits. Cardiacspecific biomarkers such as troponin-I, troponin-T and CK-MB have been used extensively to predict myocardial injury and ischaemia. This prospective study investigateed the level of troponin-I release in both off-pump and CPB-technique CABG surgery, as well as postulated a relationship of troponin release and post-operative neurological outcome. A total of 44 adult patients undergoing coronary artery bypass graft (CABG) were enrolled into either an off-pump or on-pump groups, with 22 patients participating in each. Group A (on-pump) underwent myocardial revascularisation with CPB and cardioplegic arrest, while Group B (off pump) underwent beating heart surgery. The measurement of troponin-I is a 1-step enzyme immunoassay method, with specificity and sensitivity set at 0.4 ug/mL. Neurological assessment was done using the NIH Stroke Scale, and neuropsychologic assessment was assessed on cognitive function using modified Weschler Memory Scale, for which scores were standardized to achieve a composite measure of concentration. A set of statistical analysis was done to correlate troponin-I release with different surgical techniques of CPB and OPCAB. Although each independent technique showed a marked rise of troponin-I from baseline to 6 hours post-operatively, the difference in troponin release was not significant between the 2 groups at specified time intervals (p=0.124). There was however a significant correlation of troponin-I release with the number of grafts used in the surgery, irrespective of the type of grafts or surgical technique. None of the patients in either group showed any neurological or cognitive deficits presenting at day 3 and day 7 post-operatively. The findings of this study demonstrate that there is no significant short-term cognitive or neurological dysfunctions post operatively, as indicated by troponin-I release in assessing the severity of myocardial injury.

Keywords

• cardiopulmonary bypass surgery
• cerebral hypoperfusion
• troponin-i