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


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.
Sezai
Akira
A
Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo 173-8610, Japan. asezai@med.nihon-u.ac.jp
Hata
Mitsumasa
M
Wakui
Shinji
S
Shiono
Motomi
M
Negishi
Nanao
N
Kasamaki
Yuji
Y
Saito
Satoshi
S
Kato
Jitsu
J
Minami
Kazutomo
K
D000368:Aged; D000450:Aldosterone / Q000097:blood; D001145:Arrhythmias, Cardiac / Q000503:physiopathology; D009320:Atrial Natriuretic Factor / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002315:Cardiopulmonary Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery; D052279:Creatine Kinase, MB Form / Q000097:blood; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011184:Postoperative Period; D012083:Renin / Q000097:blood; D015427:Reperfusion Injury / Q000503:physiopathology / Q000517:prevention & control; D016277:Ventricular Function, Left / Q000187:drug effects* / Q000502:physiology; D020257:Ventricular Remodeling / Q000187:drug effects* / Q000502:physiology
D020097:Natriuretic Peptide, Brain; D000450:Aldosterone; D009320:Atrial Natriuretic Factor; D052279:Creatine Kinase, MB Form; D012083:Renin