Perioperative Myocardial Injury and Hemodynamic Changes in Robot-Assisted Radical Prostatectomy: a Prospective Observational Study

Robot-assisted radical prostatectomy involves carbon dioxide pneumoperitoneum and prolonged steep Trendelenburg positioning, which may significantly affect cardiovascular physiology. This study aimed to evaluate perioperative myocardial injury and associated hemodynamic changes in patients undergoing robotic prostatectomy. In this prospective observational study, 75 patients undergoing elective robot-assisted radical prostatectomy were included. High-sensitivity cardiac troponin I (hs-cTnI) was measured preoperatively and at 24 and 48 h postoperatively. Myocardial injury was defined as hs-cTnI ≥ 45 ng/L. Perioperative troponin changes (Δ hs-cTnI), intraoperative mean arterial pressure (MAP) trends, and the predictive value of the Revised Cardiac Risk Index (RCRI) were analyzed. Continuous data were analyzed across the cohort using a multiple linear regression model to evaluate the absolute change in troponin levels (Δhs-cTnI) as a function of clinical and operative risk factors. Myocardial injury occurred in 9.3% of patients at 24 h and 13.3% at 48 h postoperatively. The incidence of myocardial injury was significantly higher in patients with an RCRI score ≥ 2 compared to those with an RCRI score < 2 (80.0% vs. 27.7%, p = 0.011). In the multiple linear regression analysis, an RCRI score ≥ 2 was a strong independent predictor of greater perioperative troponin elevation ( p = 0.006), whereas pneumoperitoneum duration showed no significant linear effect ( p = 0.320). Additionally, low-range postoperative troponin variations (a 20% relative rise) were detected in 18.4% of patients whose absolute values remained below the clinical diagnostic threshold. MAP decreased following pneumoperitoneum (≈ 15%), and intraoperative hypotension occurred in 14 patients. Patients with myocardial injury demonstrated greater perioperative increases in hs-cTnI and a trend toward lower intraoperative MAP values. Myocardial injury after noncardiac surgery (MINS) occurs in a notable proportion of patients undergoing robot-assisted radical prostatectomy. While intraoperative pneumoperitoneum duration shows no linear relationship with troponin elevation, a baseline RCRI score ≥ 2 is a powerful independent predictor, supporting targeted postoperative troponin surveillance in cardiovascularly vulnerable patients. The study was registered at ClinicalTrials.gov (NCT06502340).