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Value of brain natriuretic peptide in the perioperative follow-up of children with valvular disease

Tissières, Pierre ; da Cruz, Eduardo ; Habre, Walid ; Aggoun, Yacine ; Mensi, Noury ; Kalangos, Afksendyios ; Beghetti, Maurice

In: Intensive Care Medicine, 2008, vol. 34, no. 6, p. 1109-1113

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    Title
    • Value of brain natriuretic peptide in the perioperative follow-up of children with valvular disease
    Author
    • Tissières, Pierre. ICU Research Laboratory, Department of Microbiology and Molecular Medicine, University of Geneva Medical School, CMU, Rue Michel-Servet 1, 1211, Geneva 4, Switzerland
    • da Cruz, Eduardo. Pediatric and Neonatal Intensive Care Division, Children's University Hospital, Geneva, Switzerland
    • Habre, Walid. Pediatric Anesthesia Unit, University Hospital, Geneva, Switzerland
    • Aggoun, Yacine. Pediatric Cardiology Unit, Department of Pediatrics, Children's University Hospital, Geneva, Switzerland
    • Mensi, Noury. Clinical Chemistry Laboratory, University Hospital, Geneva, Switzerland
    • Kalangos, Afksendyios. Service of Cardiovascular Surgery, University Hospital, Geneva, Switzerland
    • Beghetti, Maurice. Pediatric Cardiology Unit, Department of Pediatrics, Children's University Hospital, Geneva, Switzerland
    Document Type
    • Postprint
    OAI-PMH Identifier
    • oai:doc.rero.ch:318258
    Summary
    Objective: To characterize N-terminal pro-brain natriuretic peptide (N-proBNP) and troponin I (TnI) profile following mitral and/or aortic valve surgery and to evaluate correlations with echocardiography measures and outcome criteria. Design and setting: Prospective cross-controlled study in auniversity children's hospital. Patients: Twenty children with acquired valvular disease requiring valvular surgery. Interventions: We prospectively studied clinical, biochemical, and echocardiographic characteristics at baseline and 6, 12, 24 h and 3-4 weeks postoperatively. Results: TnI peaked 6 h after surgery and remained elevated during the first 24 h. N-proBNP was significantly lower 3-4 weeks after surgery than during the perioperative period. Overall, N-proBNP was correlated with the Pediatric Heart Failure Index, left ventricle shortening fraction, left atrium to aorta ratio, left ventricle mass index, end-systolic wall stress, and with outcome measures such as inotropic score, duration of inotropic support, and ICU length of stay. Preoperative N-proBNP was significantly more elevated in patients with complicated outcome than in patients with uneventful postoperative course. Conclusions: In pediatric valvular patients, perioperative N-proBNP is apromising risk stratification predicting factor. It is correlated with evolutive echocardiographic measures, need for inotropic support, and ICU length of stay