Abstract
Background
Concomitant cryoablation is routinely performed in patients with atrial fibrillation
who undergo minimally invasive atrioventricular (AV) valve surgery. While biomarker
thresholds for postoperative myocardial infarction (pMI) are established in coronary
artery bypass surgery, no clear thresholds exist after concomitant cryoablation in
endoscopic valve surgery. This study aimed to analyze the perioperative cardiac biomarker
release patterns in this patient cohort and to evaluate the applicability of SCAI-defined
pMI thresholds.
Methods
We retrospectively analyzed patients who underwent endoscopic AV valve surgery from
2018 to 2024, comparing those with cryoablation (n = 165; mean age: 66.5 ± 9.5 years) to those without (n = 513; mean age: 62.4 ± 12.0 years). Perioperative creatine kinase–myocardial band
(CK-MB) and troponin T (TnT) levels were measured before surgery, at 1 and 4 hours
after surgery, and on postoperative day 1 (1POD). In-hospital outcomes were also assessed.
Results
Cryoablation significantly increased CK-MB (6.4 × ULN vs. 2.4 × ULN, p < 0.001) and TnT (257 × ULN vs. 80 × ULN, p < 0.001). Compared with SCAI pMI criteria (CK-MB > 10 × ULN; TnT > 70 × ULN), CK-MB
remained below the threshold, while TnT exceeded it in most cases (p < 0.05). Despite these elevations, clinical pMI was rare (two cases vs. three cases).
In-hospital mortality did not differ significantly between the groups (1.2% vs. 1.6%;
p = 1.000).
Conclusion
Cryoablation during minimally invasive AV valve surgery markedly increases postoperative
cardiac biomarkers without higher clinical pMI rates. Procedure-specific biomarker
thresholds and validation of SCAI criteria are essential for accurate diagnosis and
patient management.
Keywords
minimally invasive mitral valve surgery - cryoablation - cardiac biomarkers
