effect of anesthetics on troponin i and с-reactive protein

Conditions: Mitral Valve Insufficiency; Aortic Valve Insufficiency; Cardiac Disease

Summary: abstract troponin is one of the cardiac biomarkers and its high level correlates to high risk of cardiac myocytes damage. c-reactive protein (crp) in cardiosurgery participates in the systemic inflammation response syndrome, and heart-lung apparatus is a powerful stimulator of the systemic inflammatory reaction. objective: to assess effect of anesthetics on troponin i and сrp in mitral, tricuspid and aortic valve replacement/plastic in adult. methods. single-center prospective randomized controlled clinical study. a total of 95 patients were assigned randomly into three groups according to the type of anesthesia: the first group of 32 patients with propofol, the second group with sevoflurane - 32 patients, and the last - 31 patients were with isoflurane. levels of the cardiac troponin i were calculated in ng/ml с using a portable fluorometric analyzer i-chromaii, manufacture of boditechmedinc (south korea). normal range: \<0.04 ng/ml. crp concentration in plasma has been determined using a biochemical analyzer biosystems ba-200 (spanish company, barcelona) according to the manufacturer's instructions. the normal level of crp is less than 5 mg/l.

the examination and treatment data of 95 patients operated in the departments of cardiovascular surgery of the city multidisciplinary hospital no. 2 were included in the study. all patients underwent mitral, aortic, tricuspid valve replacement/plasty under cardiopulmonary bypass (cpb) conditions. this research work was conducted between 2021 and 2023. to calculate the sample size, we used the formula n=t2\*d\*n/confidence interval\*n+t2\*α, which will allow to identify the static significance of the study. inclusion criteria: insufficiency of mitral, tricuspid and aortic valves of 3-4th degree; only planned surgeries; age range 40-60 years old; patients corresponding to ii-iii grade according to the scale of the american society of anaesthesiologists. exclusion criteria: pregnancy; acute coronary syndrome; hemodynamic instability. all patients were assigned randomly into three groups according to the type of anesthesia: the first group of 32 patients with propofol, the second group with sevoflurane - 32 patients, and the last - 31 patients were with isoflurane. the level of cardiac troponin i were calculated in ng/ml using a portable fluorometric analyzer i-chromaii, production of boditechmedinc (south korea). the normal range: \<0.04 ng/ml. the analyzer triage® meter pro of alere san diego inc. production (usa). three blood samples were taken in the patients before the anaesthesia, in 12 hours post-surgery and in 48 hours post-surgery. blood samples were taken in the sterile test-tubes, containing no edta and heparin, centrifugated and stored at temperature -20 °с to avoid the erroneously low results. crp concentrations in plasma were determined using the biochemical analyzer biosystems ba-200 (spanish company, barcelona) according to the manufacturer's instructions. the normal level of crp is less than 5 mg/l. blood samples were taken in the patients before the anaesthesia, 1st day post-surgery, 3rd and 5th days post-surgery.

Eligibility criteria:
inclusion criteria: * the age is between 50-65 years old; * mitral and aortic valve insufficiency grade 3-4; * participants of both sexes will be included in the study; * planned surgical interventions; * signed informed consent. exclusion criteria: * pregnancy (risk to the baby and mother) * hypertensive disease * coronary artery disease; * current unstable angina pectoris; * preoperative hemodynamic instability, defined as the use of vasopressors;

Keywords: mitral valve insufficiency aortic valve insufficiency troponin i propofol isoflurane sevoflurane