Postoperative B-type natriuretic peptide monitoring for the assessment of the magnitude of shunting through Blalock-Taussig anastomoses. (15th December 2017)

• Record Type: Journal Article
• Authors: Mirabile, Cristian; Mazzola, Alessandra; Valeanu, Liana; Lopez-Lopez, Vanessa; Barbanti, Claudio; Biselli, Camilla; Hennequin, Carole; Malekzadeh-Milani, Sophie; Bojan, Mirela
• Is Part Of: International journal of cardiology. Volume 249(2017)
• Page Start: 151
• Page End: 155
• Publication Date: 2017-12-15
• Subjects: Infant -- Cardiovascular surgical procedures -- Modified Blalock-Taussig procedure -- Natriuretic peptide -- Brain -- Postoperative complications -- Decision support techniques; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2017.08.075
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: The Modified Blalock-Taussig shunt (MBTS) is the most common palliative operation performed in patients with complex cardiac defects. Postoperative morbidity and mortality rates are high, mainly due to shunt thrombosis and over-shunting. Over-shunting may be difficult to identify postoperatively based on conventional criteria. Since plasma B-type natriuretic peptide (BNP) concentrations correlate with the magnitude of shunting in various left-to-right shunt cardiac defects, we investigated its ability to identify postoperative MBTS over-shunting. Methods and results: This retrospective, observational study included 42 consecutive patients (median age 9.50 days, IQR: 6.00–58.25) undergoing MBTS for obstruction of the pulmonary blood flow at a tertiary referral pediatric cardiac center. The BNP threshold concentrations which accurately predicted outcome and MBTS over-shunting were derived using the ROC methodology. 443 BNP concentrations were analysed. The presence of atrio-ventricular valve regurgitation was the most important component of overall variance (72.75%). In 34 patients without regurgitation, BNP concentrations were predictive of a duration of mechanical ventilation > 8 days and of intensive care stay > 11 days, with ROC areas of 0.655 [0.597–0.719], 0.650 [0.589–0.711], a negative predictive value for the > 1035 pg mL − 1 threshold of 0.93 and 0.96 respectively. SaO2 was less accurate for the prediction of both outcomes. In patients in whom the pulmonary flow was entirely MBTS-supplied, a BNP concentrations > 1052 pg mL − 1 was predictive of a pulmonary-to-systemic ratio > 2. Conclusion: In MBTS patients without atrio-ventricular valve regurgitation, maintaining BNP below 1000 pg mL − 1 may represent a therapeutic target to avoid over-shunting.