B-type natriuretic peptide levels predict outcomes in infants undergoing cardiac surgery in a lesion-dependent fashion.

Abstract

OBJECTIVE:

B-type natriuretic peptide is used in the diagnosis, risk stratification, and management of adult patients with cardiac disease. However, its use in infants with congenital heart disease has been limited, particularly in the perioperative period. Our objective was to determine the alterations in perioperative B-type natriuretic peptide levels and their predictive value on postoperative outcomes, in infants undergoing congenital heart surgery.

METHODS:

We prospectively enrolled 115 patients: 24 with univentricular heart disease undergoing a modified Norwood procedure, 11 with d-transposition of the great arteries, 55 with hemodynamically important left-to-right shunt, and 25 with tetralogy of Fallot undergoing primary repair. Clinical data and B-type natriuretic peptide samples were collected before and 2, 12, and 24 hours after cardiopulmonary bypass. Univariate analysis and multivariate linear regression analysis were performed.

RESULTS:

The perioperative B-type natriuretic peptide levels were lesion specific. Patients with d-transposition of the great arteries and univentricular heart disease had high preoperative B-type natriuretic peptide levels that decreased postoperatively, and those with hemodynamically important left-to-right shunts and tetralogy of Fallot had lower preoperative levels that increased during the first 12 hours postoperatively. The patients with univentricular heart disease with an adverse outcome had a significantly greater 24-hour B-type natriuretic peptide level than those without (P < .05). Those with hemodynamically important left to right shunts and an adverse outcome had a greater 12-hour B-type natriuretic peptide level than those without (P < .05). A 12-hour postoperative/preoperative ratio greater than 45 was 100% sensitive and 82% specific for an adverse outcome in the patients with tetralogy of Fallot.

CONCLUSIONS:

The perioperative changes in B-type natriuretic peptide levels and their ability to predict outcomes are lesion-specific. Characterization of these changes might be useful in caring for infants after congenital heart surgery.

• Authors: Rambod Amirnovin, Roberta L Keller, Christina Herrera, Jong-Hau Hsu, Sanjeev Datar, Tom R Karl, Ian Adatia, Peter Oishi, Jeffrey R Fineman
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 145 Issue 5 Pg. 1279-87 (May 2013) ISSN: 1097-685X [Electronic] United States
• PMID: 22914252 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Chemical References

• Biomarkers
• Natriuretic Peptide, Brain
• Lactic Acid

Topics

• Biomarkers (blood)
• Cardiac Surgical Procedures (adverse effects, mortality)
• Female
• Heart Defects, Congenital (blood, diagnosis, mortality, physiopathology, surgery)
• Heart Ventricles (abnormalities, surgery)
• Hemodynamics
• Humans
• Infant
• Infant, Newborn
• Lactic Acid (blood)
• Male
• Multivariate Analysis
• Natriuretic Peptide, Brain (blood)
• Norwood Procedures
• Perioperative Period
• Predictive Value of Tests
• Prospective Studies
• Risk Factors
• Sensitivity and Specificity
• Tetralogy of Fallot (blood, surgery)
• Time Factors
• Transposition of Great Vessels (blood, surgery)
• Treatment Outcome