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Postoperative B-type natriuretic peptide monitoring for the assessment of the magnitude of shunting through Blalock-Taussig anastomoses.
- Source :
-
International Journal of Cardiology . Dec2017, Vol. 249, p151-155. 5p. - Publication Year :
- 2017
-
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. SaO 2 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. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 01675273
- Volume :
- 249
- Database :
- Academic Search Index
- Journal :
- International Journal of Cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 126062687
- Full Text :
- https://doi.org/10.1016/j.ijcard.2017.08.075