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.
Bibliographical noteFunding Information:
This research was supported in part by grants K08 HL086513 (P.E.O.), K23 HL079922 (R.L.K.), HL61284 (J.R.F.), and UL RR024131-01 from the National Center for Research Resources, all from the National Institutes of Health, and from the Foundation Leducq (J.R.F.) and Biosite Diagnostic (J.R.F.). J.H.H. was supported in part by the Department of Pediatrics, Kaohsiung Medical University Hospital, Taiwan.