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J Thorac Cardiovasc Surg 2008;135:746-753
© 2008 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

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

Jong-Hau Hsu, MDa,d, Peter E. Oishi, MDa, Roberta L. Keller, MDa, Omar Chikovani, MDa, Tom R. Karl, MDb, Anthony Azakie, MDb, Ian Adatia, MBChBa, Jeffrey R. Fineman, MDa,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
d Department of Pediatrics, Kaohsiung Medical University, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

Received for publication August 30, 2007; revisions received October 5, 2007; accepted for publication October 31, 2007.

* Address for reprints: Jeffrey R. Fineman, MD, Department of Pediatrics, UCSF Medical Center, 513 Parnassus Avenue, Box 0106, San Francisco, CA 94143. (Email: jeff.fineman{at}ucsf.edu).

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






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