Lactate Dehydrogenase Levels after aortic valve replacement: What do they tell us?

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Thoracic and Cardiovascular Surgeon Pub Date : 2024-11-01 DOI:10.1055/a-2454-9020
Laura Rings, Loreta Mavrova-Risteska, Achim Haeussler, Vasileios Ntinopoulos, Matteo Tanadini, Hector Rodriguez Cetina Biefer, Omer Dzemali
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Abstract

Introduction: Lactate dehydrogenase (LDH) is a standard postoperative marker for hemolysis in the presence of paravalvular leakage (PVL) after aortic valve replacement (AVR). LDH is elevated in certain valves by a fluttering phenomenon. Previous studies suggested a correlation between microparticles (MP) and LDH elevation after AVR. We analyze the postoperative relevance of LDH after AVR with transapical transcatheter aortic valves (TA-TAV) or rapid deployment valves (RDV).

Method: We retrospectively analyzed the data from patients who received an AVR with RDV and TA-TAV groups between 2015-2018. We compared PVL and LDH levels before and after surgery, transvalvular gradients, heart block that required pacemaker implantation, and 30-day mortality.

Results: 138 consecutive patients were selected: 79 patients in the RDV group (37 Sorin Perceval valve, 42 Edwards Intuity valves) and 59 in the TA-TAV group (Edwards Sapien valve). TA-TAV-group were older (median 10 years) and with higher incidence of PVL (Odds ratio 11, 95% CI from 2.5 - 73.2, p-value 0.04)). TA-TAV-Group showed lower levels of LDH despite higher rates of PVL while the Perceval valve trended towards higher LDH values. Additionally, the RDV group showed an increased arrhythmia profile (p=0.0041) although the results show lower incidence in pacemaker implantation (95 % CI 0.05 - 1.65, p=0.635). 30-day mortality was similar between groups.

Conclusion: Our data do not support the association between hemolysis and PVL despite elevated LDH in suture-free valves. LDH could be a marker of extreme heart muscle output or fluttering phenomena and not a marker of hemolysis after sutureless AVR.

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主动脉瓣置换术后的乳酸脱氢酶水平:它们能告诉我们什么?
简介:乳酸脱氢酶(LDH)是主动脉瓣置换术(AVR)术后出现腔室旁渗漏(PVL)时溶血的标准标志物。某些瓣膜会出现瓣膜扑动现象,从而导致 LDH 升高。以前的研究表明,微颗粒(MP)与主动脉瓣置换术后 LDH 升高之间存在相关性。我们分析了使用经心尖经导管主动脉瓣(TA-TAV)或快速展开瓣(RDV)进行 AVR 术后 LDH 的相关性:我们回顾性分析了2015-2018年间接受RDV和TA-TAV组AVR的患者数据。我们比较了手术前后的 PVL 和 LDH 水平、跨瓣梯度、需要植入起搏器的心脏传导阻滞以及 30 天死亡率:我们选取了138例连续患者:79例RDV组(37例Sorin Perceval瓣膜、42例Edwards Intuity瓣膜)和59例TA-TAV组(Edwards Sapien瓣膜)。TA-TAV 组患者年龄较大(中位数为 10 岁),PVL 发生率较高(Odds ratio 11,95% CI 从 2.5 到 73.2,p-value 0.04)。TA-TAV 组尽管 PVL 发生率较高,但 LDH 水平较低,而 Perceval 瓣膜的 LDH 值则呈上升趋势。此外,尽管结果显示起搏器植入发生率较低(95 % CI 0.05 - 1.65,p=0.635),但RDV组的心律失常情况有所增加(p=0.0041)。两组患者的30天死亡率相似:结论:尽管无缝合瓣膜的 LDH 升高,但我们的数据并不支持溶血与 PVL 之间的关联。LDH可能是无缝线自体瓣膜置换术后心肌极度输出或扑动现象的标志,而不是溶血的标志。
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来源期刊
CiteScore
3.40
自引率
6.70%
发文量
365
审稿时长
3 months
期刊介绍: The Thoracic and Cardiovascular Surgeon publishes articles of the highest standard from internationally recognized thoracic and cardiovascular surgeons, cardiologists, anesthesiologists, physiologists, and pathologists. This journal is an essential resource for anyone working in this field. Original articles, short communications, reviews and important meeting announcements keep you abreast of key clinical advances, as well as providing the theoretical background of cardiovascular and thoracic surgery. Case reports are published in our Open Access companion journal The Thoracic and Cardiovascular Surgeon Reports.
期刊最新文献
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