Natriuretic peptides for perioperative management of cardiac surgery

Abstract

Atrial natriuretic peptide (carperitide) is used to treat heart failure in Japan, while brain natriuretic peptide (nesiritide) is employed in Europe/USA. Patients undergoing cardiac surgery have a complex underlying pathologic state that features increased levels of neurohumoral factors due to activation of the renin-angiotensin-aldosterone system and/or increased sympathetic activity. We considered that perioperative administration of carperitide could be beneficial for cardiac surgery patients, and we have conducted clinical investigations of its use. This article reviews the effects of natriuretic peptides in cardiac surgery patients based on our experience and on previous reports about perioperative management with carperitide or nesiritide.

Advent of New perioperative care for fluid management after cardiovascular surgery: A review of current evidence

“…As for long-term outcome, a previous large randomized study showed that tolvaptan had no effects on long-term mortality or heart failure-related morbidity [16]. On the other hand, carperitide was found to have a strong influence on long-term outcome because of its suppression of the renin-angiotensin-aldosterone system [13]. Although tolvaptan has been shown to have no effect on the renin-angiotensin-aldosterone system [19,21,22], its administration in heart failure patients is considered to improve short-and mid-term patient outcomes.…”

“…Furthermore, perioperative administration of low-dose carperitide or nesiritide is considered to be beneficial following cardiac surgery. Cardiac surgery patients have been reported to achieve good long-term results with either drug, suggesting that low-dose natriuretic peptide therapy can be an important aspect of perioperative management due to possible cardioprotective and renoprotective effects [13].…”

“…Spironolactone, an aldosterone blocker, is also used as an adjunct to other diuretics as well as to improve congestive heart failure. Furthermore, it was reported that an intravenous administration of carperitide increased urine output, GFR, and renal blood flow in patients with acute renal failure and cardiac failure after cardiac surgery [13]. In addition, nesiritide increases GFR, and also produces diuresis and natriuresis in a dose-dependent manner [9,13].…”

“…Furthermore, it was reported that an intravenous administration of carperitide increased urine output, GFR, and renal blood flow in patients with acute renal failure and cardiac failure after cardiac surgery [13]. In addition, nesiritide increases GFR, and also produces diuresis and natriuresis in a dose-dependent manner [9,13]. Since introduction of carperitide or nesiritide, nothing has been introduced to act as diuretics by new mechanisms.…”

N-Terminal of the Prohormone Brain Natriuretic Peptide Predicts Postoperative Cardiogenic Shock Requiring Extracorporeal Membrane Oxygenation

“…The process of NT-proBNP secretion by cardiomyocytes occurs in response to an increase in their voltage in the course of increased pre- and/or after-load. An increase in the concentration of BNP and the prohormone NT-proBNP in the blood is demonstrated, among other things, by the activation of the compensation mechanism, which already occurs in the period preceding the appearance of symptoms of heart failure [ 11 , 12 , 13 , 14 ]. The predictive ability of NT-proBNP has been reported in numerous publications on various cardiovascular disorders, including aortic stenosis, heart failure, coronary artery disease, myocardial infarction, congenital heart disease, and postoperative hemodynamic instability [ 15 , 16 , 17 , 18 , 19 , 20 , 21 ].…”