Martin Christmann1, Emanuela R Valsangiacomo Büchel1, Hitendu Dave1, Dietrich Klauwer2, Anna Cavigelli-Brunner1
1 University Children's Hospital, Heart Center, Pediatric Cardiology and Cardiac Surgery; Children's Research Center, University of Zurich, Zurich, Switzerland
2 Children's Research Center, University of Zurich; University Children's Hospital, Heart Center, Department of Intensive Care Medicine and Neonatology, Zurich, Switzerland
Background : The period between stage I and II procedure for treatment of hypoplastic left heart syndrome (HLHS) bears high mortality and morbidity.
Methods : We sought to analyze the prognostic value of Troponin T/I (Trop), a well-recognized marker for myocardial damage and heart failure, for predicting outcome in a retrospective analysis of 70 infants with HLHS at our institution between March 2001 and October 2014.
Results : Stage I procedure consisted of Norwood I operation in 35 (50%) and Hybrid-approach in 22 (31%) patients. Palliative care was chosen for 13 (19%) patients. Trop values were collected from clinical charts and were analyzed in relation to the overall outcome. Trop was significantly higher after Norwood I operation in comparison to Hybrid-approach (median 7.1 g/l (0.7-20.9), vs 1.2 g/l (0.3-17.9), P < 0.001). Overall mortality of treated patients was 39% (22 patients). Survival was 54% (19 patients) after Norwood and 73% (16 patients) after Hybrid-approach. Independently from the procedure used, maximal Trop and initial lactate values were significantly higher in non-survivors than in survivors, with median Trop of 9 g/l (0.6-18.8) vs. 3.4 g/l (0.4-20.9), P 0.007, and median lactate of 3.7 mmol/L (1.6-25) vs. 2.9 mmol/L (0.3-14.6), p 0.03. Reinterventions were required in 17 (30%) patients, 4 (11%) after Norwood and 13 (59%) after Hybrid procedure. No correlation was found between the need for reintervention and Trop levels in the interstage period.
Conclusions : Patients with HLHS have significantly higher Trop levels after Norwood procedure than after Hybrid-approach. Maximal Trop values were related to mortality, but did not correlate with the need for reinterventions.
Dr. Martin Christmann
Pediatric Heart Center, University Children's Hospital, Steinwiesstrasse 75, 8032 Zurich
Source of Support: None, Conflict of Interest: None
[FULL TEXT] [PDF]*