Efficacy of low-dose continuous infusion of alpha-human atrial natriuretic peptide (hANP) during cardiac surgery: possibility of postoperative left ventricular remodeling effect.

Abstract

BACKGROUND:

The aim of the present study was to evaluate the efficacy of alpha-human atrial natriuretic peptide (hANP) in cardiac surgery under cardiopulmonary bypass (CPB).

METHODS AND RESULTS:

A prospective randomized study was conducted with 150 patients who underwent scheduled coronary artery bypass grafting to compare a group of patients receiving 0.02 microg x kg(-1) x min(-1) of hANP from the initiation of CPB with a group not receiving hANP. Hemodynamics, levels of atrial and brain natriuretic peptides (BNP), angiotensin-II and aldosterone, renin activity, and left ventricular (LV) function were examined. The hANP group showed significantly lower renin activity and lower levels of angiotensin-II and aldosterone during the early postoperative period, compared with the non-hANP group. The incidence of postoperative ventricular arrhythmia and the postoperative peak level of creatine kinase-MB were significantly lower in the hANP group. BNP at 1 month after surgery and measures of LV function were also significantly lower in the hANP group.

CONCLUSIONS:

Low-dose continuous infusion of hANP during cardiac surgery not only had a compensatory effect for the imperfections of CPB during the early postoperative period but also an inhibitory effect on postoperative LV remodeling and a reduction in ischemia/reperfusion injury. hANP should be part of the postoperative care for cardiac surgery.

• Authors: Akira Sezai, Mitsumasa Hata, Shinji Wakui, Motomi Shiono, Nanao Negishi, Yuji Kasamaki, Satoshi Saito, Jitsu Kato, Kazutomo Minami
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 70 Issue 11 Pg. 1426-31 (Nov 2006) ISSN: 1346-9843 [Print] Japan
• PMID: 17062965 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Natriuretic Peptide, Brain
• Aldosterone
• Atrial Natriuretic Factor
• Creatine Kinase, MB Form
• Renin

Topics

• Aged
• Aldosterone (blood)
• Arrhythmias, Cardiac (physiopathology)
• Atrial Natriuretic Factor (administration & dosage, pharmacology, therapeutic use)
• Blood Pressure (drug effects, physiology)
• Cardiopulmonary Bypass (methods)
• Coronary Artery Disease (surgery)
• Creatine Kinase, MB Form (blood)
• Dose-Response Relationship, Drug
• Female
• Humans
• Infusions, Intravenous
• Male
• Middle Aged
• Natriuretic Peptide, Brain (blood)
• Postoperative Period
• Renin (blood)
• Reperfusion Injury (physiopathology, prevention & control)
• Ventricular Function, Left (drug effects, physiology)
• Ventricular Remodeling (drug effects, physiology)