Sustained use of nesiritide to aid in bridging to heart transplant.
Patients with end-stage heart failure awaiting heart transplant are often maintained on continuous intravenous inotropic therapy. However, this therapy alone is often inadequate for maintenance of appropriate pulmonary artery pressure and stable clinical course. Nesiritide, B-type natriuretic peptide, is a recently released intravenous vasodilator for short-term use in patients with decompensated heart failure. This report details experience in four patients in whom this agent was used to bridge to transplant for prolonged periods (11-35 days) with added clinical benefit and without obvious tolerance. This suggests that new strategies for pretransplant management may be needed.
Hill
James A
JA
Heart Failure/Transplantation Program, Division of Cardiology, University of Florida, Gainesville, Florida, USA. hillja@medicine.ufl.edu
Hsu
Kevin
K
Pauly
Daniel F
DF
Schofield
Richard
R
Aranda
Juan M
JM
D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000150:complications; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003327:Coronary Disease / Q000150:complications; D004232:Diuretics / Q000627:therapeutic use; D004280:Dobutamine / Q000627:therapeutic use; D004298:Dopamine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000627:therapeutic use; D045283:Natriuretic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D020097:Natriuretic Peptide, Brain; D011300:Preoperative Care / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists
D002316:Cardiotonic Agents; D004232:Diuretics; D045283:Natriuretic Agents; D020097:Natriuretic Peptide, Brain; D004280:Dobutamine; D020105:Milrinone; D004298:Dopamine