Cardiac troponin T measurement following cardiac surgery in children with congenital heart defects predicts adverse outcomes

OBJECTIVES: Testing for high-sensitivity cardiac troponin (hs-cTn) often occurs following pediatric cardiac surgery, although evidence regarding its utility remains heterogeneous. This study aimed to assess the prognostic value of postoperative hs-cTnT patterns detected within 48 h after cardiac surgery. METHODS: Serum hs-cTnT (Roche Diagnostics, 5th generation assay) concentrations were measured post-operatively at three time points: upon pediatric intensive care unit (PICU) admission (T1), 13 h after admission (T2), and 24 h after T2 (T3). Surgical and postoperative variables were recorded. The outcome was a composite of 30-day mortality and/or PICU stay >10 days. Multivariable logistic regression and model discrimination were evaluated. RESULTS: Over 15 months, 154 patients (56.5 % male) with a median age of 3.8 (25th-75th percentile: 1.2-7.8) months and a median Risk Assessment for Congenital Heart Surgery score of 2, were included in this study. The outcome occurred in 24 % of the population (with the 30-day mortality rate being 7.8 %). The time point of the highest recorded hs-cTnT concentration, and not the concentration, was significantly associated with the outcome (p=0.001). Patients, whose peak hs-cTnT concentration occurred later after surgery had a sixfold higher risk of the adverse outcome. Urgent/emergent procedures were associated with a 3.6-fold increase in relative risk, and each additional minute of cardiopulmonary bypass (CPB) time conferred a 1.6 % incremental increase in risk. The multivariate model including time to troponin peak, CPB duration, need for urgent/emergent procedures showed a good discriminatory ability (c-statistic=0.84; 95 %CI: 0.78-0.90). CONCLUSIONS: Timing of hs-cTnT elevation post cardiac surgery is a valuable prognostic marker in children.