B-type natriuretic peptide as prognostic marker in tetralogy of Fallot surgery.
BACKGROUND
B-type natriuretic peptide has been extensively studied in patients with cardiovascular disease, but its impact on the perioperative outcome of patients with cyanotic congenital heart defects is still unclear. We assessed the perioperative changes in B-type natriuretic peptide levels and their correlation with preoperative factors and clinical outcomes in a large homogenous group of patients with tetralogy of Fallot undergoing definitive repair at a tertiary care center.


METHODS
A prospective study was undertaken in the cardiac operating room and intensive care unit at a single institution; 250 patients with tetralogy of Fallot undergoing intracardiac repair under cardiopulmonary bypass were studied. B-type natriuretic peptide levels were taken at 3 time points and correlated with clinical variables.


RESULTS
Baseline B-type natriuretic peptide levels correlated with the degree of cyanosis in all 4 groups. B-type natriuretic peptide levels at 24 h after admission to the intensive care unit correlated with mortality in the adult subset of patients. B-type natriuretic peptide levels > 290 pg mL(-1) in the intensive care unit predicted an increased probability of adverse clinical outcomes.


CONCLUSIONS
We demonstrated a rise in serum B-type natriuretic peptide levels in patients with tetralogy of Fallot undergoing definitive repair on cardiopulmonary bypass. B-type natriuretic peptide levels may be monitored to identify patients with cyanosis at increased risk of an augmented inflammatory response to cardiopulmonary bypass.
Department of Cardiac Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.
Poonam Malhotra
PM
Kapoor
Department of Cardiac Anesthesiology, All India Institute of Medical Sciences, New Delhi, India mkknso@gmail.com.
Arun
A
Subramanian
Department of Cardiac Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.
Vishwas
V
Malik
Department of Cardiac Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.
Usha
U
Kiran
Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Delhi, India.
Devagourou
D
Velayoudham
D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D003490:Cyanosis / Q000097:blood / Q000209:etiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007194:India; D007223:Infant; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011183:Postoperative Complications / Q000097:blood / Q000401:mortality; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D013771:Tetralogy of Fallot / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation; D055815:Young Adult
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
Biological markers; brain; cardiac surgical procedures; cardiopulmonary bypass; natriuretic peptide; postoperative complications; tetralogy of Fallot