ORIGINAL ARTICLE Arterial Switch Operation and Plasma Biomarkers: Analysis and Correlation with Early Postoperative Outcomes Raffaele Giordano 1,2 • Massimiliano Cantinotti 1 • Luigi Arcieri 1 • Vincenzo Poli 1 • Vitali Pak 1 • Bruno Murzi 1 Received: 22 February 2017 / Accepted: 2 May 2017 / Published online: 8 May 2017 Ó Springer Science+Business Media New York 2017 Abstract The aims of our study were to describe plasma brain natriuretic peptide (BNP), Troponin I (TnI), and Cystatin C (Cys-C) concentration kinetics in the postop- erative period after arterial switch operation in neonate, and to test the correlation between the plasma biomarkers and early clinical outcomes. We prospectively enrolled 29 neonates who underwent ASO. All patients received Cus- todiol cardioplegia. Blood samples were collected preop- eratively (one day before) and in the ICU immediately after admission, and then 6, 12, 24, and 48 h after surgery. TnI peak (mean 17.23 ± 7.0 ng/mL) occurred between the arrival in the ICU and the 6th hour, then we had a constant decrease. TnI had a good correlation with the inotropic support time (r = 0.560, p = 0.0015) and ICU time (r = 0.407, p = 0.028), less than with ventilation and Hospital stay (r = 0.37, p = 0.0451 and r = 0.385, p = 0.0404). BNP peak (mean 4773.79 ± 2724.52 ng/L) was in the preoperative time with a constant decrease after the operation and it had no significant correlations with clinical outcomes. The CyS-C had the highest preoperative values, which decreased during the operating phase, and then constantly increased upon arrival to the ICU with a peak at 48 h (mean 1.76 ± 0.35 mg/L). CyS-C peak had a good correlation with a plasmatic creatinine peak (r = 0.579, p = 0.0009) but not with other clinical out- comes. Our study demonstrated significant correlations between the Tnl peak and early clinical outcomes in neo- nates undergoing arterial switch operation. Other plasma biomarkers such as the BNP and CyS-C had no direct correlation. Keywords Custodiol Á Brain natriuretic peptide Á Troponin Á Cystatin Á Transposition of great artery Introduction The arterial switch operation (ASO) has become the sur- gical treatment of choice for neonates with transposition of the great arteries (TGA) with favorable early and long-term clinical outcomes [1]. There are many risk factors for mortality after ASO [2–4] such as prematurity, the presence of other congenital heart, longer cardiopulmonary bypass (CPB) time, post- operative serum lactate level, and the need for postopera- tive inotropic support. Cardiac troponin I (TnI) is a specific and sensitive marker of myocardial cell injury after pediatric open-heart surgery and the absolute levels have been shown in infants and children to be dependent on pathology, to correlate very well with the extent of perioperative myocardial damage, and to allow anticipation of the postoperative course [5, 6]. The presence of plasma B-type natriuretic peptide (BNP) was first described in 1988 in porcine brain [7]. This peptide is secreted by both left and right ventricles in response to volume increased ventricular pressure [8]. In neonates, BNP concentrations can predict adverse outcome in the postoperative period after ASO for TGA with potential clinical applications [9]. & Raffaele Giordano raf_jordan@inwind.it 1 Pediatric Cardiac Surgery Unit, Heart Hospital, Tuscany Foundation CNR ‘‘G. Monasterio’’, Massa, Italy 2 Department of Advanced Biomedical Sciences, Adult and Pediatric Cardiac Surgery, University of Naples ‘‘Federico II’’, Naples, Italy 123 Pediatr Cardiol (2017) 38:1071–1076 DOI 10.1007/s00246-017-1621-x