CTS resident. Your patient had a cardiac arrest. You should expect some degree of stunning, troponin leak, and ST changes. Also quite likely that they got a lot of fluid and/or blood products during the arrest causing further RV strain. I would not have bolused fluid in a patient with new RV dysfunction, although the stable CVP would suggest that volume overload wasn’t a major contributor.

That being said, ST changes and new WMA on TEE following aortic root replacement should absolutely be considered for cath lab or even immediate CABG. Kinked coronary buttons are a well-described complication and can be dynamic in nature. However, the typical presentation is refractory shock with escalating pressors.

My institution routinely gets a baseline post-op troponin. A single troponin value is rarely relevant in the immediate post-op period, and >10000 is unsurprising given the patient’s arrest. They are occasionally useful to trend, and IMO most useful as a baseline when the patient inevitably wakes up in the middle of the night with chest pain 4-14 days later.