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J Thorac Cardiovasc Surg 2008;135:98-105
© 2008 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

N-terminal B-type natriuretic peptide levels in pediatric patients with congestive heart failure undergoing cardiac surgery

Rowan Walsh, MD^a, Clark Boyer, MD^a,_*, Jared LaCorte, MD^a,, Vincent Parnell, MD^b, Cristina Sison, PhD^c, Devyani Chowdhury, MD^a,, Kaie Ojamaa, PhD^a,d,_*

^a Division of Pediatric Cardiology, Department of Pediatrics, Schneider Children’s Hospital, New Hyde Park, New York
^b Department of Cardiothoracic Surgery, Schneider Children’s Hospital, New Hyde Park, New York
^c Biostatistics Unit, The Feinstein Institute for Medical Research, Manhasset, New York
^d Center for Oncology/Cell Biology, The Feinstein Institute for Medical Research, Manhasset, New York.

Received for publication April 20, 2007; revisions received August 6, 2007; accepted for publication August 15, 2007.

^_* Address for reprints: Kaie Ojamaa, PhD, The Feinstein Institute for Medical Research, 350 Community Dr, Manhasset, NY 11030. (Email: kojamaa{at}nshs.edu).

Objectives: The objectives of this study were to measure circulating N-terminal B-type natriuretic peptide levels in pediatric patients undergoing surgical repair of congenital heart lesions with left ventricular volume overload and to determine whether presurgical and immediate postoperative N-terminal B-type natriuretic peptide levels could predict patient outcomes after surgical intervention.

Methods: Thirty-eight children aged 1 to 36 months undergoing surgical repair of cardiac lesions with left ventricular volume overload were studied. Plasma N-terminal B-type natriuretic peptide levels were measured preoperatively and at 2, 12, 24, 48, and 72 hours after surgical intervention and were assessed for their predictive value of postoperative outcomes. Plasma N-terminal B-type natriuretic peptide levels were also measured in 34 similarly aged healthy children.

Results: Patient preoperative N-terminal B-type natriuretic peptide levels were significantly higher than those of healthy control subjects (3085 ± 4046 vs 105 ± 78 pg/mL). Preoperative N-terminal B-type natriuretic peptide levels correlated with the complexity of surgical repair, as measured by cardiopulmonary bypass time (r = 0.529, P < .001), and with postoperative measures, including fractional inhaled oxygen requirements registered at 12 hours (r = 0.443, P = .005) and duration of mechanical ventilation (r = 0.445, P = .005). Plasma N-terminal B-type natriuretic peptide levels increased 5-fold within 12 hours after cardiopulmonary bypass (14,685 ± 14,317 pg/mL). Multivariable regression analysis showed that the preoperative N-terminal B-type natriuretic peptide level was a significant predictor of duration of intensive care unit stay (P = .02) and that the peak postoperative N-terminal B-type natriuretic peptide level was a significant predictor of the intensity of overall medical management, as assessed by using the therapeutic intervention scoring system (P = .01).

Conclusion: Plasma N-terminal B-type natriuretic peptide levels measured preoperatively and postoperatively can be a prognostic indicator in the management of the pediatric patient after surgical intervention for congenital heart repair.