The Association Between Cardiac Biomarker NT-proBNP and 30-Day Readmission or Mortality After Pediatric Congenital Heart Surgery

Background: Very little is known about clinical and biomarker predictors of readmissions following pediatric congenital heart surgery. The cardiac biomarker N-terminal pro-brain natriuretic peptide (NT-proBNP) can help predict readmission in adult populations, but the estimated utility in predicting risk of readmission or mortality after pediatric congenital heart surgery has not previously been studied. Our objective was to evaluate the association between pre- and postoperative serum biomarker levels and 30-day readmission or mortality for pediatric patients undergoing congenital heart surgery. Methods: We measured pre- and postoperative NT-proBNP levels in two prospective cohorts of 522 pediatric patients <18 years of age who underwent at least one congenital heart operation from 2010 to 2014. Blood samples were collected before and after surgery. We evaluated the association between pre- and postoperative NT-proBNP with readmission or mortality within 30 days of discharge, using multivariate logistic regression, adjusting for covariates based on the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Mortality Risk Model. Results: The Johns Hopkins Children's Center cohort and the Translational Research Investigating Biomarker Endpoints in Acute Kidney Injury (TRIBE-AKI) cohort demonstrate event rates of 12.9% and 9.4%, respectively, for the composite end point. After adjustment for covariates in the STS congenital risk model, we did not find an association between elevated levels of NT-proBNP and increased risk of readmission or mortality following congenital heart surgery for either cohort. Conclusions: In our two cohorts, preoperative and postoperative values of NT-proBNP were not significantly associated with readmission or mortality following pediatric congenital heart surgery. These findings will inform future studies evaluating multimarker risk assessment models in the pediatric population.

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Elevated Levels of Urinary Biomarkers TIMP-2 and IGFBP-7 Predict Acute Kidney Injury in Neonates after Congenital Heart Surgery

Journal of Pediatric Intensive Care ◽

10.1055/s-0041-1740359 ◽

2021 ◽

Author(s):

Michelle Ramírez ◽

Sujata Chakravarti ◽

Jaclyn McKinstry ◽

Yasir Al-qaqaa ◽

Raj Sahulee ◽

...

Keyword(s):

Acute Kidney Injury ◽

Congenital Heart ◽

Heart Surgery ◽

Kidney Injury ◽

Acute Kidney Injury Network ◽

Congenital Heart Surgery ◽

Adverse Outcomes ◽

Tissue Inhibitor Of Metalloproteinase ◽

Stress Injury ◽

Stage 1

Abstract Objectives: This article investigated the utility of urine biomarkers tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein-7 (IGFBP-7) in identifying acute kidney injury (AKI) in neonates after congenital heart surgery (CHS). TIMP-2 and IGFBP-7 are cell cycle arrest proteins detected in urine during periods of kidney stress/injury. Methods: We conducted a single-center, prospective study between September 2017 and May 2019 with neonates undergoing CHS requiring cardiopulmonary bypass (CPB). Urine samples were analyzed using NephroCheck prior to surgery and 6, 12, 24, and 96 hours post-CPB. All patients were evaluated using the Acute Kidney Injury Network (AKIN) criteria. Wilcoxon rank sum tests were used to compare the medians of the [TIMP-2*IGFBP-7] values in the AKIN negative and positive groups at each time point. Receiver operating characteristic curves were used to measure how well the [TIMP-2*IGFBP-7] values predict AKIN status. Results: Thirty-six patients were included. No patients met the AKIN criteria for AKI preoperatively. Postoperatively, 19 patients (53%) met the AKIN criteria for AKI diagnosis: 13 (36%) stage 1, 5 (14%) stage 2, and 1 (3%) stage 3. None required renal replacement therapy. At the 24-hour time points, patients who met the AKIN criteria for AKI had a statistically significantly higher [TIMP-2*IGFBP7] values than the patients without AKI (1.1 vs. 0.27 [ng/mL]2/1,000) at 24 hours (adj-p = 0.0019). Conclusion: AKI is a serious complication associated with adverse outcomes in patients undergoing cardiac surgery. [TIMP-2*IGFBP-7] urinary level 24 hours after CPB is a good predictor of AKI in this population.

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Compromised Ventilation Caused by Transesophageal Echocardiography Probe in Pediatric Patients Undergoing Congenital Heart Surgery - A case report -

Korean Journal of Anesthesiology ◽

10.4097/kjae.2008.54.6.682 ◽

2008 ◽

Vol 54 (6) ◽

pp. 682 ◽

Cited By ~ 2

Author(s):

Sung Yong Park ◽

Sun Kyung A Park ◽

You Sun Hong ◽

Yong Woo Hong

Keyword(s):

Case Report ◽

Transesophageal Echocardiography ◽

Congenital Heart ◽

Heart Surgery ◽

Pediatric Patients ◽

Congenital Heart Surgery

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Early Impact of the COVID-19 Pandemic on Congenital Heart Surgery Programs Across the World: Assessment by a Global Multi-Societal Consortium

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135120949462 ◽

2020 ◽

Vol 11 (6) ◽

pp. 689-696

Author(s):

Eleftherios M. Protopapas ◽

Mauro Lo Rito ◽

Vladimiro L. Vida ◽

George E. Sarris ◽

Christo I. Tchervenkov ◽

...

Keyword(s):

Congenital Heart ◽

Heart Surgery ◽

Pediatric Population ◽

Congenital Heart Surgery ◽

Future Health ◽

Surgical Practice ◽

Infectious Risk ◽

The World ◽

Effects On Children ◽

The Impact

The coronavirus disease 2019 (COVID-19) pandemic currently gripping the globe is impacting the entire health care system with rapidly escalating morbidities and mortality. Although the infectious risk to the pediatric population appears low, the effects on children with congenital heart disease (CHD) remain poorly understood. The closure of congenital heart surgery programs worldwide to address the growing number of infected individuals could have an unintended impact on future health for COVID-19-negative patients with CHD. Pediatric and congenital heart surgeons, given their small numbers and close relationships, are uniquely positioned to collectively assess the impact of the pandemic on surgical practice and care of children with CHD. We present the results of an international survey sent to pediatric and congenital heart surgeons characterizing the early impact of COVID-19 on the care of patients with CHD.

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