Preoperative B-type natriuretic peptide levels are associated with outcome after total cavopulmonary connection (Fontan).
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.
Department of Pediatrics, University of California, San Francisco, Calif; Cardiovascular Research Institute, University of California, San Francisco, Calif.
Monique
M
Radman
Department of Pediatrics, University of California, San Francisco, Calif.
Roberta L
RL
Keller
Department of Pediatrics, University of California, San Francisco, Calif; Cardiovascular Research Institute, University of California, San Francisco, Calif.
Peter
P
Oishi
Department of Pediatrics, University of California, San Francisco, Calif.
Sanjeev A
SA
Datar
Department of Pediatrics, University of California, San Francisco, Calif.
Kari
K
Wellnitz
Department of Surgery, University of California, San Francisco, Calif.
Anthony
A
Azakie
Department of Surgery, Stanford University, Palo Alto, Calif.
Frank
F
Hanley
Department of Anesthesia, Stanford University, Palo Alto, Calif.
Danton
D
Char
Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Jong-Hau
JH
Hsu
Department of Anesthesia, Children's Hospital Los Angeles, Los Angeles, Calif.
Rambod
R
Amrinovin
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Ian
I
Adatia
Department of Pediatrics, University of California, San Francisco, Calif; Cardiovascular Research Institute, University of California, San Francisco, Calif. Electronic address: Jeff.fineman@ucsf.edu.
Jeffrey R
JR
Fineman
D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects / Q000401:mortality; D006330:Heart Defects, Congenital / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010166:Palliative Care; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D011446:Prospective Studies; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain