Preoperative N-terminal pro-brain natriuretic peptide is associated with Fontan outcomes

Hsin-Chia Lin; Shu-Chien Huang; Mei-Hwan Wu; Jou-Kou Wang; Ming-Tai Lin; Chun-An Chen; Chun-Wei Lu; Yih-Sharng Chen; Shuenn-Nan Chiu

doi:10.1016/j.jtcvs.2021.11.082

Preoperative N-terminal pro-brain natriuretic peptide is associated with Fontan outcomes

J Thorac Cardiovasc Surg. 2022 Sep;164(3):770-780.e3. doi: 10.1016/j.jtcvs.2021.11.082. Epub 2021 Dec 10.

Authors

Hsin-Chia Lin¹, Shu-Chien Huang², Mei-Hwan Wu³, Jou-Kou Wang³, Ming-Tai Lin³, Chun-An Chen³, Chun-Wei Lu³, Yih-Sharng Chen², Shuenn-Nan Chiu⁴

Affiliations

¹ Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Pediatrics, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan.
² Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan.
³ Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan.
⁴ Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan. Electronic address: michael@ntuh.gov.tw.

PMID: 35031137
DOI: 10.1016/j.jtcvs.2021.11.082

Abstract

Objective: The role of preoperative N-terminal pro-brain natriuretic peptide level in patient outcomes after the Fontan operation remains unclear.

Methods: The medical records of all patients who underwent their first Fontan operation from June 2011 to October 2019 in our tertiary referral pediatric cardiac center were retrospectively reviewed. Preoperative hemodynamic factors and N-terminal pro-brain natriuretic peptide were analyzed to test the association of mortality and morbidity.

Results: We enrolled 110 patients (men/women 62/48; median age, 4.1 [3.4, 5.8] years; median follow-up period, 4.28 [2.31, 6.71] years). Almost all operations were extracardiac conduits (98.2%). Primary outcomes of death, Fontan takedown, and heart transplantation were observed in 9 patients (8.2%). Abnormal ventricular contractility, elevated preoperative pulmonary artery pressure, high pulmonary vascular resistance index, and high log₁₀ N-terminal pro-brain natriuretic peptide level were associated with poor outcomes.

Secondary outcomes: atrioventricular valve regurgitation moderate or greater, elevated pulmonary artery pressure, high pulmonary vascular resistance index, and high log₁₀ N-terminal pro-brain natriuretic peptide level were associated with rehospitalization due to heart failure. Multivariable Cox regression analysis revealed that log₁₀ N-terminal pro-brain natriuretic peptide was the only significant predictor of all primary and secondary outcomes. A scoring system including factors of pulmonary artery pressure, pulmonary vascular resistance index, and N-terminal pro-brain natriuretic peptide was established, and the risk stratification is associated with outcomes after the Fontan operation.

Conclusions: High preoperative N-terminal pro-brain natriuretic peptide was associated with poor outcomes after the Fontan operation.

Keywords: Fontan operation; N-terminal pro-brain natriuretic peptide; congenital heart disease; extracardiac conduit.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Child
Child, Preschool
Female
Fontan Procedure* / adverse effects
Heart Defects, Congenital* / surgery
Humans
Male
Natriuretic Peptide, Brain
Peptide Fragments
Retrospective Studies

Substances

Peptide Fragments
pro-brain natriuretic peptide (1-76)
Natriuretic Peptide, Brain