title: Experimental investigation of "hANP shot" using human atrial natriuretic peptide for myocardial protection in cardiac surgery.
abstract: BACKGROUND
  We investigated myocardial protection by human atrial natriuretic peptide (hANP) during cardiac surgery without cardioplegia and determined whether suppression of myocardial ischemic reperfusion injury by hANP allows intraoperative aortic cross-clamp time to be prolonged.
  
  
  RESULTS
  Thirty-two pigs were placed on cardiopulmonary bypass. Experimental pigs were divided into 4 groups: 15 min clamping; hANP 15 min clamping; 30 min clamping; and hANP 30 min clamping. In both hANP groups, a 100 μg dose of hANP was administered after clamping. Left ventricular function, premature ventricular contractions (PVCs), histopathological studies, 8-isoprostane, myocardial Ca(2+), and ATP concentrations were determined. Comparison of the myocardial contractile force indicator E(max), in the 30 min groups, showed a significantly higher recovery rate in the hANP than in the control group. PVC numbers were significantly lower in the hANP than in the control groups for both arrest durations. On microscopic examination, hANP reduced ischemic reperfusion injury in the 30 min groups. The myocardial ATP level was significantly higher in the hANP 30 min than in the control 30 min group. Increases in 8-isoprostane and myocardial Ca(2+) concentrations were significantly inhibited in both hANP groups.
  
  
  CONCLUSIONS
  This study demonstrated that hANP ameliorates ischemic reperfusion injury, improves postoperative myocardial contractility, and reduces reperfusion arrhythmias. We suggest that hANP allows aortic cross-clamping to be prolonged and thereby exerts a direct myocardial protective effect against cardiac arrest during cardiac surgery.
authors.affiliation: The Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan. shunji86@hotmail.com
authors.forename: Shunji
authors.initials: S
authors.lastname: Osaka
authors.forename: Akira
authors.initials: A
authors.lastname: Sezai
authors.forename: Shinji
authors.initials: S
authors.lastname: Wakui
authors.forename: Kazuma
authors.initials: K
authors.lastname: Shimura
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Taniguchi
authors.forename: Mitsumasa
authors.initials: M
authors.lastname: Hata
authors.forename: Motomi
authors.initials: M
authors.lastname: Shiono
mesh_terms: D000818:Animals; D009320:Atrial Natriuretic Factor / Q000008:administration & dosage / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000379:methods; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D017682:Myocardial Stunning / Q000517:prevention & control; D013552:Swine
chemical_list: D009320:Atrial Natriuretic Factor