Perioperative B-type natriuretic peptide levels predict outcome after bidirectional cavopulmonary anastomosis and total cavopulmonary connection
Perioperative B-type natriuretic peptide levels predict outcome after bidirectional cavopulmonary anastomosis and total cavopulmonary connection
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DOI：
10.1016/j.jtcvs.2007.10.040
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发表时间：
2008-04-01
影响因子：
6
通讯作者：
Fineman, Jeffrey R.
中科院分区：
文献类型：
--
作者：
Hsu, Jong-Hau;Oishi, Peter E.;Fineman, Jeffrey R.
目的：本研究的目的是确定婴儿和儿童接受双向腔静脉吻合术或全腔静脉连接术的围手术期B型利钠肽水平，以及B型利钠肽水平对结果的预测价值。分别于治疗前和治疗后2，12，在36例接受双向腔静脉吻合术（n = 525）或全腔静脉连接术（n = 511）的连续患者中，术后24 h。B型利钠肽水平作为outcome.Results的预测指标进行了评价：B型利钠肽水平增加手术后，在大多数患者在12小时达到峰值。在双向腔静脉吻合组中，12小时B型利钠肽>= 500 pg/mL的患者机械通气持续时间较长（165 6 149小时vs 20 6 9小时，P = 5.004），重症监护室住院时间更长（11 6 7 d vs 4 6 2 d，P = 5 0 0 1），住院时间较长（2 0 d 6 12 vs 9 d 6 5，P = 5 0 0 3）。12小时B型利钠肽>= 500 pg/mL预测非计划性外科手术或经导管心脏介入治疗（包括移植）的敏感性为80%，特异性为80%（P = 5.03）。在全腔静脉连接组中，与预后良好的患者相比，全腔静脉连接失败的患者术前B型利钠肽水平最高（88 6 46 pg/mL vs 15 6 6 pg/mL，P = 5.03）。术后B型利钠肽水平可预测双向腔静脉吻合术的预后，早期和晚期全腔静脉连接失败的患者术前水平均高于预后良好的患者。
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 = 525) or total cavopulmonary connection (n = 511). 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 >= 500 pg/mL had a longer duration of mechanical ventilation (165 6 149 hours vs 20 6 9 hours, P = 5.004), longer intensive care unit stay (11 6 7 days vs 4 6 2 days, P = 5.001), and longer hospital stay (20 days 6 12 vs 9 days 6 5, P = 5.003). A 12-hour B-type natriuretic peptide >= 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 = 5.03). 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 6 46 pg/mL vs 15 6 6 pg/mL, P = 5.03).Conclusion: 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.