Relationship of Off-Pump Coronary Artery Bypass Surgery with the Cardiac Enzyme Troponin T, LVEF, TAPSE and Post-Operative Recovery.

Corresponding Author:
Subhendu Sekhar Mahapatra,
Department of CTVS,
SSKM Hospital, #244,
AJC Bose Road, Kolkata-700020,
West Bengal, India.
E-mail: subhendu.mahapatra1972@gmail.com

ABSTRACT

BACKGROUND

Cardiovascular diseases (CVD) are the leading cause of death globally including India. Ischemic heart disease is the most common cause of death. There is a sharp rise in Off Pump Coronary Artery Bypass Surgery (OPCAB), which increases cardiac enzymes like Troponin T, that is used as prognostic guide. In triple vessel disease 40 to 50% cases involve right ventricle, therefore along with left ventricular ejection fraction (LVEF), Tricuspid Annular Plane Systolic Excursion (TAPSE) can be used as a prognostic guide, which can be measured by noninvasive doppler echocardiography.

METHODS

Patients with specific criteria who underwent OPCAB surgery from January 2018 to March 2019 were studied. Both pre- and post-operative (14-16 hours) Troponin T (TropT) sensitivity tests were done and only preoperative Trop T negative patients were selected for the study. Postoperative patients were divided into 2 groups, TropT positive and negative. Echocardiography was done on the day before surgery, on postoperative day 5 (POD5) and postoperative day 30 (POD30). Results were compared between  the two groups.

RESULTS

Among 88 patients thus selected, 34 patients (38.63%) were Trop T positive, and 54 patients (61.37%) were Trop T negative. On post-operative day 5, increase in brain natriuretic peptide (BNP), decrease in TAPSE and decrease in haemoglobin were significant in Trop T positive group. Need for ventilation and postoperative hospital stay were significantly prolonged in positive groups. In POD30, decrease in albumin, decrease in LVEF and TAPSE all are significant in TropT positive group.

CONCLUSIONS

It is important to determine the prognosis of OPCAB patients in early postoperative period. Troponin T has a significant prognostic value in OPCAB patients supported by LVEF and TAPSE.

KEY WORDS

Triple Vessel Disease, OPCAB, Troponin T, LVEF, TAPSE, Outcome