title: Perioperative B-type natriuretic peptide levels predict outcome after bidirectional cavopulmonary anastomosis and total cavopulmonary connection.
abstract: 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 > or = 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 > or = 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).
  
  
  CONCLUSIONS
  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.
authors: Department of Pediatrics, University of California, San Francisco, Calif 94143, USA.
authors: Jong-Hau
authors: JH
authors: Hsu
authors: Peter E
authors: PE
authors: Oishi
authors: Roberta L
authors: RL
authors: Keller
authors: Omar
authors: O
authors: Chikovani
authors: Tom R
authors: TR
authors: Karl
authors: Anthony
authors: A
authors: Azakie
authors: Ian
authors: I
authors: Adatia
authors: Jeffrey R
authors: JR
authors: Fineman
mesh_terms: D000714:Anastomosis, Surgical; D013504:Cardiovascular Surgical Procedures; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000601:surgery; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000601:surgery
chemical_list: D020097:Natriuretic Peptide, Brain