The Role of Markers of Myocardial Damage in Predicting Postoperative Multiple Organ Dysfunction Syndrome and 30-Day Mortality in Patients Undergoing Heart Valve Surgery.

Background

Multiple organ dysfunction syndrome (MODS) is a serious complication and a leading cause of death in patients undergoing heart valve surgery. The main aim of the present study was to assess the predictive capacity of selected perioperative parameters, including Troponin T levels, to predict the occurrence of postoperative MODS and 30-day mortality in patients undergoing heart valve surgery.

Methods

This prospective study included a group of patients with hemodynamically severe symptomatic valvular heart disease who underwent valve surgery. The primary endpoint was postoperative multiple organ dysfunction syndrome (MODS), defined as the dysfunction of at least two organs/systems, including cardiogenic shock, perioperative stroke, respiratory failure requiring prolonged mechanical ventilation, and/or postoperative acute kidney injury requiring renal replacement therapy. The secondary endpoint was death during the 30-day follow-up. Logistic regression was used to assess the relationships between the variables.

Results

In total, 739 patients undergoing valvular heart surgery were included in this study. The primary end point was observed in 45 patients. Preoperative hemoglobin level (p = 0.01), red cell distribution width (RDW) (p = 0.001) and troponin T level measured on the first day after surgery (TnT II) (p < 0.001) were independent predictors of the primary endpoint. EuroSCORE II (p = 0.002) and TnT II (p < 0.001) were independent predictors of 30-day mortality.

Conclusions

MODS is a clinical condition that is associated with a high risk of death. Troponin T levels measured within the first 24 h postoperatively may be useful in predicting postoperative MODS and 30-day mortality in patients undergoing heart valve surgery as a complement to commonly used risk calculators.