Objective: To asses the expression of fluid-regulating hormones, vasopressin, angiotensin II (AT II), atrial (ANP) and brain natriuretic peptide (BNP) and evaluate their influence on early outcome following single ventricle (SV) palliation

Methods: Preoperative and postoperative plasma samples were prospectively collected among patients undergoing SV palliation(BDG = 23 and Fontan = 25). Analysis was performed to determine the potential influence of preoperative neurohormonal profile on clinical outcome(incidence of prolonged pleural effusions, lenght of mechanical ventilation[MV], ICU and hospital stay [LOS].

Results: The median duration of MV, ICU and LOS for the entire cohort were 6 hrs, 29 hrs and 11 days respectively. Median duration of CPB and myocardial ischemia were 73 and 37 minutes. There was no operative mortality. Significant differences across SV stages were observed for QP/QS (p<0.001), PA pressure (p<0.01), transpulmonary gradients (p<0.03) and SVC saturation (p<0.0001). Preoperative BNP predicted likelihood of prolonged MV (p<0.00001), and LOS (p<0.05) in the Fontan cohort while preoperative AT II predicted duration of MV (p<0.000000), ICU (p<0.00001) and LOS (p<0.0003) among patients undergoing BDG. Perioperative expression of ANP and BNP did not correlate with the morphology of the SV, duration of cardiopulmonary bypass or myocardial ischemia.

Conclusion: Preoperative neurohormonal profile can predict early postoperative course following SV palliation. The influence of different hormones during the SV staging sequence suggests specific mechanisms possibly related to the underlying physiology, rather than operative factors.