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J Thorac Cardiovasc Surg 2006;131:632-638
© 2006 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Alterations in plasma B-type natriuretic peptide levels after repair of congenital heart defects: A potential perioperative marker

Chie-Youn Shih, MD a , Anil Sapru, MD a , Peter Oishi, MD a , Anthony Azakie, MD b , Tom R. Karl, MD b , Cynthia Harmon, BS a , Ritu Asija, MD a , Ian Adatia, MB, ChB a , Jeffrey R. Fineman, MD a , c , *

a Department of Pediatrics, University of California, San Francisco, Calif
b Department of Surgery, University of California, San Francisco, Calif
c Cardiovascular Research Institute, University of California, San Francisco, Calif

Received for publication September 23, 2005; revisions received October 26, 2005; accepted for publication October 31, 2005.

* Address for reprints: Jeffrey R. Fineman, MD, Department of Pediatrics, 505 Parnassus Ave, Box 0106, San Francisco, CA 94143. (Email: jeff.fineman{at}ucsf.edu).

OBJECTIVES: B-type natriuretic peptide, a cardiac hormone with diuretic, natriuretic, and vasoactive properties, is used in the diagnosis, risk stratification, and management of adult cardiac patients. However, no study has yet determined the prognostic value of B-type natriuretic peptide after surgical intervention for congenital heart disease. The objectives of this study were (1) to determine alterations in B-type natriuretic peptide levels after repair of congenital heart disease with cardiopulmonary bypass and (2) to investigate potential associations between B-type natriuretic peptide levels and outcomes in this patient population.

METHODS: Fifty-one infants and children undergoing repair of congenital heart disease were studied. B-type natriuretic peptide levels were measured before and after surgical intervention, and the ability of the postoperative 12-hour B-type natriuretic peptide level to predict postoperative outcomes was evaluated.

RESULTS: B-type natriuretic peptide levels increased after separation from cardiopulmonary bypass, with an 8-fold peak increase at 12 hours (P < .005). Postoperative 12-hour B-type natriuretic peptide levels were associated with the duration of mechanical ventilation and the presence of a low cardiac output state after surgical intervention. On multivariate analysis, the 12-hour B-type natriuretic peptide level was an independent predictor of the duration of mechanical ventilation. In fact, B-type natriuretic peptide levels of greater than 540 pg/mL predicted mechanical ventilation beyond 48 hours, with a sensitivity of 88.9% and a specificity of 82.5%. In addition, B-type natriuretic peptide levels of greater than 815 pg/mL predicted the presence of a low cardiac output state within 48 hours after surgical intervention, with a sensitivity of 87.5% and a specificity of 90.2%.

CONCLUSIONS: B-type natriuretic peptide determinations might be a useful tool for clinicians caring for infants and children after surgical intervention for congenital heart disease.

Abbreviations and Acronyms BNP = B-type natriuretic peptide; CHF = congestive heart failure; CPB = cardiopulmonary bypass; PCICU = Pediatric Cardiac Intensive Care Unit; SvO 2 = mixed venous oxyhemoglobin saturation




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