title: Efficacy of Tolvaptan on Fluid Management After Cardiovascular Surgery Using Cardiopulmonary Bypass.
abstract: OBJECTIVE
  To investigate the efficacy of the selective vasopressin V2-receptor antagonist tolvaptan in postoperative fluid management after cardiovascular surgery using cardiopulmonary bypass.
  
  
  METHODS
  A retrospective cohort study.
  
  
  METHODS
  A tertiary care center.
  
  
  METHODS
  The study comprised 99 patients undergoing cardiovascular surgery using cardiopulmonary bypass.
  
  
  METHODS
  Oral tolvaptan was administered after surgery.
  
  
  RESULTS
  Fifty-one patients treated with tolvaptan were compared with 48 patients treated with intravenous diuretics. Urine volume, the time interval until the patients' body weight returned to the preoperative value, and the length of oxygen dependency after extubation were assessed as surrogate markers for resolution of fluid overload. Urine output on postoperative days 1 and 2 was significantly higher in the tolvaptan-treated patients (29.2 v 20.1 mL/kg/day, p = 0.001; 43.0 v 27.4 mL/kg/day, p<0.001, respectively). Postoperative body weight returned to baseline in 49 tolvaptan-treated patients compared with 33 patients treated with intravenous diuretics (96.1% v 68.8%, p<0.001). Among those with successful body weight reduction, the time interval was shorter in the tolvaptan-treated patients (5 v 7 days, p = 0.006). The length of oxygen dependency after extubation also was shorter in the tolvaptan-treated patients (2 v 3 days, p = 0.006). The urine osmolarity reduction rate before and 4 hours after the first dose of tolvaptan emerged as a significant predictor of its efficacy with a cutoff point of 33.7%, sensitivity of 0.73, and specificity of 0.67 (p = 0.030).
  
  
  CONCLUSIONS
  Tolvaptan facilitated early improvement of postoperative fluid overload after cardiovascular surgery.
authors: Cardiothoracic Surgery, Anjo Kosei Hospital, Anjo City, Aichi, Japan. Electronic address: Hisato.ito@gmail.com.
authors: Hisato
authors: H
authors: Ito
authors: Cardiothoracic Surgery, Anjo Kosei Hospital, Anjo City, Aichi, Japan.
authors: Toru
authors: T
authors: Mizumoto
authors: Cardiothoracic Surgery, Anjo Kosei Hospital, Anjo City, Aichi, Japan.
authors: Hironori
authors: H
authors: Tempaku
authors: Cardiothoracic Surgery, Anjo Kosei Hospital, Anjo City, Aichi, Japan.
authors: Kazuya
authors: K
authors: Fujinaga
authors: Cardiothoracic Surgery, Anjo Kosei Hospital, Anjo City, Aichi, Japan.
authors: Yasuhiro
authors: Y
authors: Sawada
authors: †Department of Thoracic and Cardiovascular Surgery, Mie University, Tsu, Mie, Japan.
authors: Hideto
authors: H
authors: Shimpo
mesh_terms: D000284:Administration, Oral; D000368:Aged; D065092:Antidiuretic Hormone Receptor Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001552:Benzazepines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D004231:Diuresis / Q000187:drug effects; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D010102:Oxygen Inhalation Therapy; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D000077602:Tolvaptan; D014556:Urine; D014883:Water-Electrolyte Imbalance / Q000188:drug therapy* / Q000209:etiology; D015431:Weight Loss / Q000187:drug effects
chemical_list: D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines; D000077602:Tolvaptan
keywords: cardiopulmonary bypass; cardiovascular surgery; diuresis; postoperative care