Postoperative serum troponin I elevation after thoracotomy versus video-assisted thoracoscopic lung resection

Morales P., Coronado C., Camio E., Matarin S., González-Tallada A., de Nadal M.

Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Dept of Anaesthesiology & Intensive Care, Barcelona, Spain

Background and Goal of Study: In high-risk patients undergoing lung resection, minimally invasive approach through video-assisted thoracoscopic surgery (VATS) is expanding and is associated with a lower incidence of major cardiopulmonary complications and mortality compared to open thoracotomy (1). Cardiac troponin-I (TnI) elevation is frequent after lung surgery (2), but its correlation with the surgical approach has not been described. The aims of this study were to determine the frequency of postoperative TnI elevation following thoracotomy or VATS lung resection in high-risk patients and its correlation with 30-day mortality.
Materials and methods: As part of routine postoperative care for all patients at high cardiac risk, we measured serum high-sensitivity TnI levels (Siemens ADVIA Centaur) during the first two postoperative days in 96 consecutive patients that underwent lobectomy (n=70) or lung wedge resection (n=26). High-risk patients were defined as ≥65 years or < 65 years with known cardiovascular risk. Patients were divided in two groups depending upon surgical approach (open thoracotomy or VATS). The specific troponin cut off used was TnI ≥0.04 ng/ml. Baseline clinical characteristics, perioperative parameters, and 30-day mortality was assessed in both groups.
Results and discussion: Of the 96 patients screened, 44 were operated on through open thoracotomy (TH group) and 52 through VATS (VATS group). The overall frequency of TnI elevation was of 32.3%. TnI elevation was detected in 14/44 patients (31.8%) in the TH group and in 17/52 patients (32.7%) in the VATS group (P-value chi-squared 0.927). Baseline clinical characteristics and perioperative parameters were similar in both groups. Overall 30-day mortality was of 3/96 patients (3.1%). 30-day mortality was of 2/44 patients (4.5%) in the TH group and 1/52 patient (1.9%) in the VATS group (P-value chi-squared 0.825).
Conclusions: In high-risk patients undergoing lung resection, the frequency of postoperative troponin elevation was similar in patients operated on through open thoracotomy and through VATS. No differences were found in early mortality between both groups. The frequency of troponin elevation was higher than the one reported in non high-risk patients (3).
References: 
1. Falcoz et al. Eur J Cardiothorac Surg. 2015;26 pii: ezv154
2. Lucrezioti et al. Rev Esp Cardiol. 2007; 60:1159-66
3. Deveraux PJ et al. JAMA. 2012; 307:2295-2304