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Thorac Cardiovasc Surg
DOI: 10.1055/a-2454-9020
Original Cardiovascular

Lactate Dehydrogenase Levels after Aortic Valve Replacement: What Do They Tell Us?

Laura Rings
1   Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
2   Department of Cardiac Surgery, City Hospital of Zurich, Site Triemli, Zurich, Switzerland
,
Loreta Mavrova-Risteska
1   Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
,
Achim Haeussler
1   Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
2   Department of Cardiac Surgery, City Hospital of Zurich, Site Triemli, Zurich, Switzerland
,
Vasileios Ntinopoulos
1   Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
2   Department of Cardiac Surgery, City Hospital of Zurich, Site Triemli, Zurich, Switzerland
,
Matteo Tanadini
3   Zurich Data Scientists GmbH, Zurich, Switzerland
,
Hector Rodriguez Cetina Biefer‡   *
1   Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
2   Department of Cardiac Surgery, City Hospital of Zurich, Site Triemli, Zurich, Switzerland
4   Center for Translational and Experimental Cardiology (CTEC), Schlieren, Switzerland
,
Omer Dzemali‡   *
1   Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
2   Department of Cardiac Surgery, City Hospital of Zurich, Site Triemli, Zurich, Switzerland
4   Center for Translational and Experimental Cardiology (CTEC), Schlieren, Switzerland
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Abstract

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

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

Results In total, 138 consecutive patients were selected for the study: 79 patients in the RDV group (37 Sorin Perceval valve, 42 Edwards Intuity valve) and 59 in the TA-TAV group (Edwards Sapien valve). TA-TAV group was older (median 10 years) and had a higher incidence of PVL (odds ratio 11, 95% confidence interval [CI] 2.5–73.2, p = 0.04)). Interestingly, the TA-TAV group showed lower levels of LDH despite higher rates of PVL. Of note, the Perceval valve trended toward higher LDH values. Additionally, the RDV group showed an increased arrhythmia profile (p = 0.0041); however, the results show lower incidence in pacemaker implantation (95% CI 0.05–1.65, p = 0.635). The 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. Our results suggest that LDH could be a marker of extreme heart muscle output or fluttering phenomenon and not a marker of hemolysis after sutureless AVR.

Keywords

aortic valve and root - heart valve surgery - heart valve - transapical - percutaneous (TAVI) - cardiac

Authors' Contribution

O.D. and H.R.C.B. contributed equally as the last authors of this manuscript due to their unparalleled expertise and collaborative efforts. Together, their combined expertise advanced the research and set a high standard for interdisciplinary collaboration in scientific studies.


* These authors contributed equally.




Publication History

Received: 12 August 2024

Accepted: 22 October 2024

Accepted Manuscript online:
01 November 2024

Article published online:
26 November 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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