Preoperative B-type natriuretic peptide levels are associated with outcome after total cavopulmonary connection (Fontan)

Monique Radman, Roberta L. Keller, Peter Oishi, Sanjeev A. Datar, Kari Wellnitz, Anthony Azakie, Frank Hanley, Danton Char, Jong Hau Hsu, Rambod Amrinovin, Ian Adatia, Jeffrey R. Fineman

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7 Scopus citations


Objective The study objective was to determine the association between preoperative B-type natriuretic peptide levels and outcome after total cavopulmonary connection. Surgical palliation of univentricular cardiac defects requires a series of staged operations, ending in a total cavopulmonary connection. Although outcomes have improved, there remains an unpredictable risk of early total cavopulmonary connection takedown. The prediction of adverse postoperative outcomes is imprecise, despite an extensive preoperative evaluation. Methods We prospectively enrolled 50 patients undergoing total cavopulmonary connection. We collected preoperative clinical data, preoperative plasma B-type natriuretic peptide levels, and postoperative outcomes, including the incidence of an adverse outcome within 1 year of surgery (defined as death, total cavopulmonary connection takedown, or the need for cardiac transplantation). Results The mean age of patients was 4.7 years (standard deviation, 2.1 years). The median (interquartile range) preoperative B-type natriuretic peptide levels were higher in patients who required total cavopulmonary connection takedown and early postoperative mechanical cardiac support (n = 3; median, 55; interquartile range, 42-121) compared with those with a good outcome (n = 47; median, 11; interquartile range, 5-17) (P <.05). A preoperative B-type natriuretic peptide level of 40 pg/mL or greater was highly associated with the need for total cavopulmonary connection takedown (sensitivity, 100%; specificity, 93%; P <.05), yielding a positive predictive value of 50% and a negative predictive value of 100%. Higher preoperative B-type natriuretic peptide levels also were associated with longer intensive care unit length of stay, longer hospital length of stay, and increased incidence of low cardiac output syndrome (P <.05). Conclusions Preoperative B-type natriuretic peptide blood levels are uniquely associated with the need for mechanical support early after total cavopulmonary connection and total cavopulmonary connection takedown, and thus may provide important information in addition to the standard preoperative assessment.

Original languageEnglish (US)
Pages (from-to)212-219
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Issue number1
StatePublished - Jul 2014

Bibliographical note

Funding Information:
This research was supported in part by Grants U01 HL101798 (to R.L.K.), K08 HL086513 (to P.O.), and HL61284 (to J.R.F.) from the National Institutes of Health , and UL RR024131-01 from the National Center for Research Resources .


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