HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Tom R. Karl Anthony Azakie Ian Adatia Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Chikovani, O. Articles by Fineman, J. R. Search for Related Content PubMed Articles by Chikovani, O. Articles by Fineman, J. R.

J Thorac Cardiovasc Surg 2007;134:1179-1187
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

B-type natriuretic peptide levels predict outcomes for children on extracorporeal life support after cardiac surgery

^a Department of Pediatrics, University of California, San Francisco, Calif
^b Department of Surgery, University of California, San Francisco, Calif
^c Pediatric Heart Center, University of California, San Francisco, Calif
^d Cardiovascular Research Institute, University of California, San Francisco, Calif
^e Department of Pediatrics Kaohsiung Medical University Hospital, Taiwan.

Received for publication December 15, 2006; revisions received March 13, 2007; accepted for publication April 9, 2007.

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

Objective: Extracorporeal life support is used in 3% to 8% of infants and children after cardiac surgery. B-type natriuretic peptide may have utility as a biomarker in these patients. The objective of this study was to investigate potential associations between changes in B-type natriuretic peptide during trials off extracorporeal life support and clinical outcome.

Methods: Ten infants and children requiring extracorporeal life support after cardiac surgery were studied prospectively. Before separation from extracorporeal life support, a shunt was placed in the circuit, allowing for temporary trials off life support. Serum lactate, arterial–venous oxyhemoglobin saturation difference, and B-type natriuretic peptide levels were determined before each trial off life support and at the end of each trial off life support, and the ability to predict postoperative outcome from these data was evaluated.

Results: During trials off extracorporeal life support, lactate, the arterial–venous oxyhemoglobin saturation difference, and B-type natriuretic peptide levels increased above pre-trial values (P < .05). Only the arterial–venous oxyhemoglobin saturation difference predicted successful separation from extracorporeal life support after a trial (P < .05). There were no associations between long-term outcome and alterations in lactate and the arterial–venous oxyhemoglobin saturation difference during the final trials off life support. However, an increase in B-type natruiretic peptide levels during the final trial off life support (trial/pre-trial ratio of >1) had a sensitivity of 80% and a specificity of 100% for predicting the need for an unplanned operation or death within 3 months (P < .05).

Conclusion: B-type natriuretic peptide determinations may be a useful tool for clinicians caring for infants and children requiring extracorporeal life support after cardiac surgery.

This article has been cited by other articles:

				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]