Key result
Elevated pericardial fluid troponin and BNP are linked to longer post-cardiac surgery ICU stay.
Why the study?
Pericardial fluid biomarkers reflect myocardial physiology and show sustained increases post-cardiac surgery, but the feasibility of analyzing intraoperative biomarkers and their association with length of stay required evaluation.
Are intraoperative pericardial fluid biomarkers (troponin and BNP) associated with length of stay after cardiac surgery?
Cohort (n=30)
No
Are intraoperative pericardial fluid biomarkers (troponin and BNP) associated with length of stay after cardiac surgery?
Intraoperative sampling of pericardial fluid is feasible and reveals local elevations of cardiac biomarkers that may predict prolonged intensive care unit stays post-surgery.
Pericardial biomarkers may aid postoperative risk stratification in cardiac surgery; hypothesis-generating and requires validation in larger cohorts.
Objective: Pericardial fluid biomarkers reflect the physiologic state of the myocardium. Previously, we showed a sustained increase in pericardial fluid biomarkers compared with blood in the 48 hours after cardiac surgery. We assess the feasibility of analyzing 9 common cardiac biomarkers from pericardial fluid collected during cardiac surgery and test a preliminary hypothesis of association between the most common biomarkers, troponin and brain natriuretic peptide, and length of stay after surgery. Methods: We prospectively enrolled 30 patients aged 18 years or more undergoing coronary artery or valvular surgery. Patients with ventricular assist devices, atrial fibrillation surgery, thoracic aorta surgery, redo surgery, concomitant noncardiac surgery, and preoperative inotropic support were excluded. Before pericardial excision during surgery, a 1-cm pericardial incision was made to insert an 18-gauge catheter and collect 10 mL of pericardial fluid. Concentrations of 9 established biomarkers of cardiac injury or inflammation including brain natriuretic peptide and troponin were measured. Zero truncated Poisson regression adjusted for Society of Thoracic Surgery Preoperative Risk of Mortality tested for a preliminary association between pericardial fluid biomarkers and length of stay. Results: Pericardial fluid was collected and pericardial fluid biomarkers resulted for all patients. Adjusted for Society of Thoracic Surgery risk, brain natriuretic peptide, and troponin were associated with increased intensive care unit and overall hospital length of stay. Conclusions: In 30 patients, pericardial fluid was obtained and analyzed for cardiac biomarkers. Adjusting for Society of Thoracic Surgery risk, pericardial fluid troponin and brain natriuretic peptide were preliminarily associated with increased length of stay. Further investigation is needed to validate this finding and to investigate the potential clinical utility of pericardial fluid biomarkers.
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Goeddel et al. (2023) conducted a cohort in Cardiac surgery (coronary artery or valvular) (n=30). Pericardial fluid biomarkers (troponin and BNP) was evaluated on Intensive care unit length of stay (IRR 0.004 for troponin; IRR 0.0002 for BNP, p=0.0007 for troponin; 0.0004 for BNP). Intraoperative pericardial fluid troponin (IRR 0.004) and brain natriuretic peptide (IRR 0.0002) were independently associated with increased intensive care unit length of stay in patients undergoing cardiac surgery.
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