Effect of two different bypass techniques on the serum troponin-T levels in newborns and children: does pH-Stat provide better protection?

Zsolt L Nagy, Mike Collins, Tracy Sharpe, Saeed Mirsadraee, Rafael R Guerrero, John Gibbs, Kevin G Watterson

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Cardiac troponin-T is a sensitive marker of myocardial damage. In a prospective study, the effect of 2 different pH strategies during cardiopulmonary bypass on ischemic myocardial injury and clinical outcome was measured in a pediatric population.

METHODS AND RESULTS: One hundred one patients (31 neonates 13.2+/-8.3 days and 70 children 34.5+/-44.1 months of age) undergoing open-heart surgery were selected to either alpha-stat (n=51) or pH-stat (n=50) acid-based management protocol. Serum troponin-T levels were measured before and 30 minutes after bypass and then 4 and 24 hours postoperatively. Surgical procedure, bypass details, inotropic support requirement, and postoperative recovery were recorded. Baseline troponin-T level was higher in neonates than in children (0.18+/-0.22 versus 0.04+/-0.05 microg/L, P=0.02). Also, a higher baseline level was found in patients with pulmonary hypertension (0.13+/-0.21 versus 0.04+/-0.05 microg/L, P=0.04). Cyanotic children showed a higher peak troponin-T level (3.76+/-3.11 versus 1.67+/-1.33 microg/L, P=0.04). Peak troponin levels showed a correlation with the length of circulatory arrest and aortic cross-clamp time. Postoperative levels remained high at 24 hours in patients requiring inotropic support. Peak troponin-T levels were significantly lower in the pH-stat group in patients with pulmonary hypertension (P=0.03) and in cases where circulatory arrest (P=0.01) or inotropic support (P=0.01) was necessary during operation than in those with alpha-stat technique. Postoperative ventilation time and length of intensive care unit stay were also significantly longer with alpha-stat than with pH-stat technique (P=0.005 and P=0.006, respectively).

CONCLUSIONS: Cardiac troponin-T sensitively reflects myocardial damage in children. Our results suggest that pH-stat acid-based management protocol may provide better protection against ischemic myocardial damage than alpha-stat technique.

Original languageEnglish
Pages (from-to)577-82
Number of pages6
Issue number5
Publication statusPublished - 5 Aug 2003


  • Acid-Base Equilibrium
  • Biological Markers
  • Cardiac Pacing, Artificial
  • Cardiopulmonary Bypass
  • Child
  • Child, Preschool
  • Female
  • Heart Arrest, Induced
  • Heart Defects, Congenital
  • Hospital Mortality
  • Humans
  • Hydrogen-Ion Concentration
  • Infant
  • Infant, Newborn
  • Length of Stay
  • Male
  • Multivariate Analysis
  • Myocardial Ischemia
  • Myocardium
  • Prospective Studies
  • Reperfusion Injury
  • Treatment Outcome
  • Troponin T


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