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Ann Thorac Surg 2006;82:1643-1648
© 2006 The Society of Thoracic Surgeons
a Department of Anesthesiology and Intensive Care, Hospital for Children and Adolescents, Finland
c Department of Cardiac Surgery, Hospital for Children and Adolescents, Finland
b Division of Intensive Care, Department of Anesthesiology and Intensive Care, Helsinki University Hospital, Helsinki, Finland
Accepted for publication May 4, 2006.
* Address correspondence to Dr Mildh, Helsinki University Hospital, Hospital for Children and Adolescents, PO Box 281, 00029 HUS, Helsinki, Finland. (Email: leena.mildh{at}hus.fi).
BACKGROUND: Cardiac troponin T has been found to be accurate predictor of complications and adverse clinical events after pediatric cardiac surgery. Contrary to adult cardiac surgery, the relationship of troponin T to patient survival after pediatric heart surgery has not been previously studied. The purpose of this study was to determine whether troponin T could predict death after pediatric open cardiac surgery.
METHODS: This was a retrospective cohort study in which data from 1001 consecutive children having cardiac surgery during a 5-year period were studied. Perioperative variables that could influence death at 30 postoperative days were evaluated.
RESULTS: Multivariate analysis, using a forward stepwise logistic regression, showed that troponin T measured on the first postoperative day was a strong independent predictor of death at 30 days. Level of troponin T greater than 5.9 µg/L on the first postoperative day predicted death (odds ratio, 10.7; 95% confidence interval: 5.2 to 22.1) as did admission lactate level greater than 5.2 mmol/L (odds ratio, 22.2; 95% confidence interval: 9.7 to 50.8) No other variable, including postoperative creatine kinase-MB mass concentration, age, diagnosis, surgical procedure, presence of cyanosis, chromosomal anomaly or ventriculotomy, duration of cardiopulmonary bypass, or aortic cross-clamp, had any independent effect on 30-day survival.
CONCLUSIONS: Cardiac troponin T level on the first postoperative day is a powerful independent risk marker of death in pediatric cardiac surgery.
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