The Journal of Thoracic and Cardiovascular Surgery
Volume 135, Issue 4 , Pages 746-753, April 2008

Perioperative B-type natriuretic peptide levels predict outcome after bidirectional cavopulmonary anastomosis and total cavopulmonary connection

  • Jong-Hau Hsu, MD

      Affiliations

    • Department of Pediatrics, University of California, San Francisco, Calif
    • Department of Pediatrics, Kaohsiung Medical University, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • ,
  • Peter E. Oishi, MD

      Affiliations

    • Department of Pediatrics, University of California, San Francisco, Calif
    • ,
  • Roberta L. Keller, MD

      Affiliations

    • Department of Pediatrics, University of California, San Francisco, Calif
    • ,
  • Omar Chikovani, MD

      Affiliations

    • Department of Pediatrics, University of California, San Francisco, Calif
    • ,
  • Tom R. Karl, MD

      Affiliations

    • Department of Surgery, University of California, San Francisco, Calif
    • ,
  • Anthony Azakie, MD

      Affiliations

    • Department of Surgery, University of California, San Francisco, Calif
    • ,
  • Ian Adatia, MBChB

      Affiliations

    • Department of Pediatrics, University of California, San Francisco, Calif
    • ,
  • Jeffrey R. Fineman, MD

      Affiliations

    • Department of Pediatrics, University of California, San Francisco, Calif
    • Cardiovascular Research Institute, University of California, San Francisco, Calif
    • Corresponding Author InformationAddress for reprints: Jeffrey R. Fineman, MD, Department of Pediatrics, UCSF Medical Center, 513 Parnassus Avenue, Box 0106, San Francisco, CA 94143.

Received 30 August 2007; received in revised form 5 October 2007; accepted 31 October 2007.

Objective

The objective of the study was to determine perioperative B-type natriuretic peptide levels in infants and children undergoing bidirectional cavopulmonary anastomosis or total cavopulmonary connection, and the predictive value of B-type natriuretic peptide levels for outcome.

Methods

Plasma B-type natriuretic peptide levels were measured before and 2, 12, and 24 hours after surgery in 36 consecutive patients undergoing bidirectional cavopulmonary anastomosis (n = 25) or total cavopulmonary connection (n = 11). B-type natriuretic peptide levels were evaluated as predictors of outcome.

Results

B-type natriuretic peptide levels increased after surgery, peaking at 12 hours in most patients. In the bidirectional cavopulmonary anastomosis group, patients with 12-hour B-type natriuretic peptide ≥ 500 pg/mL had a longer duration of mechanical ventilation (165 ± 149 hours vs 20 ± 9 hours, P = .004), longer intensive care unit stay (11 ± 7 days vs 4 ± 2 days, P = .001), and longer hospital stay (20 days ± 12 vs 9 days ± 5, P = .003). A 12-hour B-type natriuretic peptide ≥ 500 pg/mL had a sensitivity of 80% and a specificity of 80% for predicting an unplanned surgical or transcatheter cardiac intervention, including transplantation (P = .03). In the total cavopulmonary connection group, preoperative B-type natriuretic peptide levels were highest in patients with total cavopulmonary connection failure compared with patients with a good outcome (88 ± 46 pg/mL vs 15 ± 6 pg/mL, P = .03).

Conclusion

Postoperative B-type natriuretic peptide levels predict outcome after bidirectional cavopulmonary anastomosis, and preoperative levels are greater in patients with both early and late total cavopulmonary connection failure compared with patients with a good outcome.

Abbreviations and Acronyms: BCPA, bidirectional cavopulmonary anastomosis, BNP, B-type natriuretic peptide, CPB, cardiopulmonary bypass, ICU, intensive care unit, LCOS, low cardiac output syndrome, mPAP, mean pulmonary artery pressure, PVR, pulmonary vascular resistance, Qp/Qs, ratio of pulmonary blood flow over systemic blood flow, SVC, superior vena cava, SVEDP, systemic ventricular end-diastolic pressure, TCPC, total cavopulmonary connection

CTSNet classification: 21

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 This research was supported in part by grants K08 HL086513 (P.E.O.), K23 HL079922 (R.L.K.), HL61284 (J.R.F.), and UL RR024131-01 from the National Center for Research Resources, all from the National Institutes of Health, and from the Foundation Leducq (J.R.F.) and Biosite Diagnostic (J.R.F.). J.H.H. was supported in part by the Department of Pediatrics, Kaohsiung Medical University Hospital, Taiwan.

PII: S0022-5223(07)01870-3

doi:10.1016/j.jtcvs.2007.10.040

The Journal of Thoracic and Cardiovascular Surgery
Volume 135, Issue 4 , Pages 746-753, April 2008

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