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CARDIOVASCULAR ANESTHESIA

The Effect of Concomitant Radiofrequency Ablation and Surgical Technique (Repair Versus Replacement) on Release of Cardiac Biomarkers During Mitral Valve Surgery

Alberto Zangrillo, MD^*, Giuseppe Crescenzi, MD^*, Giovanni Landoni, MD^*, Stefano Benussi, MD, Martina Crivellari, MD^*, Federico Pappalardo, MD^*, Enrica Dorigo, MD, Carlo Pappone, MD, PhD, and Ottavio Alfieri, MD

*Departments of Cardiovascular Anesthesia, Cardiac Surgery, and Cardiology, IRCCS San Raffaele Hospital, Milan, Italy

Address correspondence and reprint requests to Giovanni Landoni, MD, Department of Cardiovascular Anesthesia, IRCCS San Raffaele Hospital, Milan, Italy, Via Olgettina 60, 20132 Milano Italy. Address e-mail to landoni.giovanni{at}hsr.it.

All patients undergoing heart surgery experience a certain amount of nonspecific myocardial injury documented by the release of cardiac biomarkers and associated with poor outcome. We investigated the role of unipolar radiofrequency ablation of atrial fibrillation on the release of cardiac biomarkers in 71 patients undergoing mitral valve surgery and concomitant left atrial ablation case-matched with 71 patients undergoing isolated mitral surgery. The study was powered to detect a 3 ng/mL difference. There was no difference between the 2 groups in terms of cardiac troponin I (10 ± 5.3 versus 12 + 10.4 ng/mL; P = 0.7) or creatine kinase-MB (50 ± 21.8 versus 57 ± 62.0 ng/mL; P = 0.5) release. Postoperative peak cardiac troponin I levels had univariate associations with the duration of cardiopulmonary bypass (P = 0.002) and aortic cross-clamping (P = 0.001) and with the surgical technique (15 ± 12 ng/mL for mitral valve replacement versus 9 ± 4.8 for mitral valve repair; P = 0.0007) at univariate analysis. Mitral valve replacement was the only independent predictor of postoperative peak release of cardiac troponin I identified with multivariate analysis (P = 0.005). Radiofrequency ablation of atrial fibrillation does not significantly increase cardiac biomarker release compared with isolated mitral surgery; mitral valve repair is associated with less release of cardiac biomarkers compared with mitral valve replacement.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999