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

OBJECTIVES: Biventricular repair (BVR) for patients with borderline hypoplastic left ventricle is challenging, and a predictor of failing BVR has not been clarified. This study aimed to analyse the z-log N-terminal pro-B-type natriuretic peptide and evaluate its usefulness in predicting outcomes after BVR. METHODS: Patients who were diagnosed with borderline left heart hypoplasia and underwent BVR 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 were collected from the first admission to the last follow-up and compared between patients with failing BVR (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 failures) following BVR. The mean value of z-log N-terminal pro-B-type natriuretic peptide before BVR was not significantly different between patients with failing BVR and those without (2.2 [1.5-3.2] vs 3.3 [2.2-3.9], P = 0.200). However, patients with failing BVR showed a continuous increase in N-terminal pro-B-type natriuretic peptide postoperatively. The value for patients with failing BVR 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 BVR. CONCLUSIONS: Elevated z-log N-terminal pro-B-type natriuretic peptide after BVR of borderline hypoplastic left ventricle seems to be a useful biomarker associated with poor outcomes.