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

doi:10.1016/j.jtcvs.2013.08.009

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

Journal article

Peer reviewed

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, …

The Journal of thoracic and cardiovascular surgery, Vol.148(1), pp.212-219

07/2014

DOI: 10.1016/j.jtcvs.2013.08.009

PMCID: PMC3968237

PMID: 24079880

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Abstract

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. 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). 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). 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.

Reoperation

Prospective Studies

Heart Defects, Congenital - surgery

Humans

Risk Factors

Child, Preschool

Postoperative Complications - surgery

Male

Palliative Care

Treatment Outcome

Biomarkers - blood

Fontan Procedure - adverse effects

Postoperative Complications - mortality

Fontan Procedure - mortality

Time Factors

Female

Heart Defects, Congenital - diagnosis

Heart Defects, Congenital - mortality

Child

Natriuretic Peptide, Brain - blood

Heart Defects, Congenital - blood

Details

Title: Subtitle: Preoperative B-type natriuretic peptide levels are associated with outcome after total cavopulmonary connection (Fontan)
Creators: Monique Radman - Department of Pediatrics, University of California, San Francisco, Calif; Cardiovascular Research Institute, University of California, San Francisco, Calif
Roberta L Keller - Department of Pediatrics, University of California, San Francisco, Calif
Peter Oishi - Department of Pediatrics, University of California, San Francisco, Calif; Cardiovascular Research Institute, University of California, San Francisco, Calif
Sanjeev A Datar - Department of Pediatrics, University of California, San Francisco, Calif
Kari Wellnitz - Department of Pediatrics, University of California, San Francisco, Calif
Anthony Azakie - Department of Surgery, University of California, San Francisco, Calif
Frank Hanley - Department of Surgery, Stanford University, Palo Alto, Calif
Danton Char - Department of Anesthesia, Stanford University, Palo Alto, Calif
Jong-Hau Hsu - Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Rambod Amrinovin - Department of Anesthesia, Children's Hospital Los Angeles, Los Angeles, Calif
Ian Adatia - Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
Jeffrey R Fineman - Department of Pediatrics, University of California, San Francisco, Calif; Cardiovascular Research Institute, University of California, San Francisco, Calif. Electronic address: Jeff.fineman@ucsf.edu
Resource Type: Journal article
Publication Details: The Journal of thoracic and cardiovascular surgery, Vol.148(1), pp.212-219
DOI: 10.1016/j.jtcvs.2013.08.009
PMID: 24079880
PMCID: PMC3968237
NLM abbreviation: J Thorac Cardiovasc Surg
ISSN: 0022-5223
eISSN: 1097-685X
Grant note: UL1 RR024131 / NCRR NIH HHS T32 HD049303 / NICHD NIH HHS M01 RR001271 / NCRR NIH HHS K08HL086513 / NHLBI NIH HHS UL RR024131-01 / NCRR NIH HHS HL61284 / NHLBI NIH HHS K08 HL086513 / NHLBI NIH HHS U01 HL101798 / NHLBI NIH HHS R01 HL061284 / NHLBI NIH HHS
Language: English
Date published: 07/2014
Academic Unit: Critical Care; Stead Family Department of Pediatrics
Record Identifier: 9984093351002771

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