Usefulness of serial N-terminal pro-B-type natriuretic peptide values after biventricular repair in patients with borderline hypoplastic left ventricle.

0 CARDIAC & CARDIOVASCULAR SYSTEMS Interdisciplinary cardiovascular and thoracic surgery Pub Date : 2025-03-19 DOI:10.1093/icvts/ivaf036

Takuya Osawa, Haonan Cheng, Jonas Palm, Carolin Niedermaier, Muneaki Matsubara, Thibault Schaeffer, Nicole Piber, Paul Philipp Heinisch, Christoph Röhlig, Alfred Hager, Peter Ewert, Jürgen Hörer, Masamichi Ono

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Abstract

Objectives: Biventricular repair for patients with borderline hypoplastic left ventricle is challenging, and a predictor of failing biventricular repair has not been clarified. This study aimed to analyze the z-log N-terminal pro-B-type natriuretic peptide and evaluate its usefulness in predicting outcomes after biventricular repair.

Methods: Patients who were diagnosed with borderline left heart hypoplasia and underwent biventricular repair from 2012 to 2022 were included. Serial N-terminal pro-B-type natriuretic peptide values were evaluated using its age-adjusted z-score. The data was collected from the first admission to the last follow-up, and compared between patients with failing biventricular repair (defined as death and haemodynamic failure) and patients with haemodynamically good biventricular outcomes.

Results: A total of 34 patients were included, and 7 patients (21%) developed adverse outcomes (5 deaths and 2 haemodynamic failure) following biventricular repair. The mean value of z-log N-terminal pro-B-type natriuretic peptide before biventricular repair was not significantly different between patients with failing biventricular repair and those without (2.2 [1.5-3.2] vs 3.3 [2.2-3.9], p = 0.200). However, patients with failing biventricular repair showed a continuous increase in N-terminal pro-B-type natriuretic peptide postoperatively. The value for patients with failing biventricular repair was higher within 7 days after BVR (p = 0.016) and at the last follow-up (p = 0.003) than those without. Postoperative z-log N-terminal pro-B-type natriuretic peptide and endocardial fibroelastosis at birth were identified as associated factors of failing biventricular repair.

Conclusions: Elevated z-log N-terminal pro-B-type natriuretic peptide after biventricular repair of borderline hypoplastic left ventricle seems to be a useful biomarker associated with poor outcomes.

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