Prognostic value of N-terminal fragment of brain natriuretic peptide in pediatric cardiac surgery

Aim. To study the level of the N-terminal fragment of brain natriuretic peptide in children with congenital heart disease after surgical treatment and to determine its prognostic value in the postoperative period.

Methods. A preoperative and postoperative examination of 113 children with congenital heart disease who were treated in the cardiac surgery department, was performed. Patients were allocated to four groups depending on the functional class of heart failure. Serum concentration of N-terminal brain natriuretic peptide fragment was determined by electrochemiluminescence before and one day after the surgery.

Results. Postoperative levels of the N-terminal fragment of brain natriuretic peptide correlated with the duration of mechanical ventilation, the time that patient spends in the intensive care unit, the intensity of cardiotonic support. On the 1st day after the surgical intervention the concentration of this peptide was significantly increased in patients of the first, second and third group, by average of 7.8 times, due to the direct effect on the heart cells, surgical trauma, influence of cardioplegic solution, heart function alteration and heart failure associated with operative and post-operative period. In 24 patients of the fourth group, the N-terminal fragment of brain natriuretic peptide has significantly decreased on the first day after surgery. In 7 patients of the fourth group, the growth of the N-peptide level was reported, complicated postoperative period, sometimes with fatal outcome, took place in these cases. The level of this marker is associated with the frequency of postoperative complications, reoperations, and its threshold level for determining high-risk group for complications was 5400 pg/ml.

Conclusion. The concentration of the N-terminal fragment of brain natriuretic peptide on day 1 after surgical intervention in patients with congenital heart disease can be used to predict the clinical course of postoperative period; the level above 5400 pg/ml is considered to be a risk factor for postoperative complications and reoperations.