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J Thorac Cardiovasc Surg 2007;134:939-945
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

B-type natriuretic peptide levels predict outcome after neonatal cardiac surgery

^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
^d Department of Pediatrics, Kaohsiung Medical University Hospital, Taiwan.

Received for publication March 1, 2007; revisions received April 10, 2007; accepted for publication April 16, 2007.

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

Objectives: Neonates undergoing cardiac surgery are at high risk for adverse outcomes. B-type natriuretic peptide is used as a biomarker in patients with cardiac disease, but the predictive value of B-type natriuretic peptide after cardiac surgery in neonates has not been evaluated. Therefore, the objective of this study was to determine the predictive value of perioperative B-type natriuretic peptide levels for postoperative outcomes in neonates undergoing cardiac surgery.

Methods: Plasma B-type natriuretic peptide determinations were made before and 2, 12, and 24 hours after surgery in 36 consecutive neonates. B-type natriuretic peptide levels and changes in perioperative B-type natriuretic peptide were evaluated as predictors of postoperative outcome.

Results: B-type natriuretic peptide levels at 24 hours were lower than preoperative levels (24-h/pre B-type natriuretic peptide ratio < 1) in 29 patients (81%) and higher (24-h/pre B-type natriuretic peptide ratio 1) in 7 patients (19%). A 24-hour/pre B-type natriuretic peptide level of 1 or greater was associated with an increased incidence of low cardiac output syndrome (100% vs 34%, P = .002) and fewer ventilator-free days (17 ± 13 days vs 26 ± 3 days, P = .002), and predicted the 6-month composite end point of death, an unplanned cardiac operation, or cardiac transplant (57% vs 3%, P = .003). A 24-hour/pre B-type natriuretic peptide level of 1 or greater had a sensitivity of 80% and a specificity of 90% for predicting a poor postoperative outcome (P = .003).

Conclusion: In neonates undergoing cardiac surgery, an increase in B-type natriuretic peptide 24 hours after surgery predicts poor postoperative outcome.

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				J.-H. Hsu, P. E. Oishi, R. L. Keller, O. Chikovani, T. R. Karl, A. Azakie, I. Adatia, and J. R. Fineman Perioperative B-type natriuretic peptide levels predict outcome after bidirectional cavopulmonary anastomosis and total cavopulmonary connection. J. Thorac. Cardiovasc. Surg., April 1, 2008; 135(4): 746 - 753. [Abstract] [Full Text] [PDF]