Experimental investigation of direct myocardial protective effect of atrial natriuretic peptide in cardiac surgery

Wakui, Shinji; Sezai, Akira; Tenderich, Gero; Hata, Mitsumasa; Osaka, Syunji; Taniguchi, Yoshiki; Köerfer, Reiner; Minami, Kazutomo

doi:10.1016/j.jtcvs.2009.08.030

Cited by 13 publications

(16 citation statements)

References 25 publications

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“…[11][12][13][14][15][16] In an experiment study, cyclic guanosine monophosphate was increased by the administration of hANP, and myocardial protective effects were reported. 17,18) Recently, continuous intravenous administration of hANP or BNP have been performed in cardiac surgery worldwide, its cardiac and reno-protective effects have been reported. 19,20) The only large-scale studies of hANP performed so far are a multicenter study of hANP administration after reperfusion therapy in patients with acute myocardial infarction (J-WIND study).…”

Section: Discussionmentioning

confidence: 99%

Results of Emergency Coronary Artery Bypass Grafting for Acute Myocardial Infarction: Importance of Intraoperative and Postoperative Cardiac Medical Therapy

Sezai¹,

Hata²,

Yoshitake³

et al. 2012

Ann Thorac Cardiovasc Surg

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Background: The results of emergency coronary artery bypass grafting (CABG) for acute myocardial infarction (AMI) are less than satisfactory, and readmission for cardiac events is common. Methods and Results: 105 patients underwent emergency CABG for AMI. We examined the long-term results of emergency CABG for AMI from the viewpoints of preoperative, intraoperative, and postoperative factors. The operative mortality rate was 11.4%. Risk factors for early death were age ≥80 years, shock, veno-arterial bypass, creatine kinase isoenzyme Mb ≥100 U/L, non-use of a left internal thoracic artery graft and an extracorporeal circulation time ≥120 min. Risk factors for late cardiac events were ejection fraction <40%, non-use of human atrial natriuretic peptide (hANP) therapy, angiotensin II receptor blockers (ARB) and aldosterone blockers, and a 3-month postoperative brain natriuretic peptide level ≥200 pg/ml. Conclusions: Early results of this study are similar to those seen in previous reports, whereas late phase results yield some new and interesting findings. We suggest that intraoperative hANP, and postoperative aldosterone blocker and ARB, following CABG for AMI, will, through control of the renin-angiotensin-aldsterone system, inhibit left ventricular remodelling, reduce the extent of infarction, and improve cardiac function, yielding a favourable long-term prognosis.

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Section: Discussionmentioning

confidence: 99%

Results of Emergency Coronary Artery Bypass Grafting for Acute Myocardial Infarction: Importance of Intraoperative and Postoperative Cardiac Medical Therapy

Sezai¹,

Hata²,

Yoshitake³

et al. 2012

Ann Thorac Cardiovasc Surg

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“…Sezai, et al reported that carperitide acted to reverse these changes in every aspect. [13][14][15][16][17][18] They administered the drug at 0.02 µg/kg/min from the start of CPB, after taking into consideration that their patients did not have heart failure before surgery and might become dehydrated as a result of fasting for one day prior to the operation. Their findings showed inhibition of the renin-angiotensin-aldosterone system and less fluid retention in the third space due to a strong diuretic action.…”

Section: Discussionmentioning

confidence: 99%

“…13) In addition, it has been reported that ANP decreases the demand for furosemide, inhibits potassium loss, reduces electrolyte imbalance, and prevents arrhythmia development during unstable conditions after surgery. [14][15][16][17][18] Thus, it has become a useful drug for perioperative and postoperative management of patients treated in our department. However, the effect on the pulmonary circulation during cardiac surgery has not been examined.…”

Section: Effects Of Continuous Infusion Of Low-dose Human Atrial Natrmentioning

confidence: 99%

Effects of Continuous Infusion of Low-dose Human Atrial Natriuretic Peptide (hANP) on the Lungs during Cardiac Surgery

Shibasaki

Fukuda

Yamada

et al. 2015

ATCS

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Objective: The objective of this study was to determine the effects of a continuous infusion of low-dose hANP on the lungs during cardiac surgery in patients under cardiopulmonary bypass (CPB). Methods: We analyzed 30 consecutive cases of cardiac surgery performed at our hospital from 2007-2008. The patients were divided into a group that received hANP (hANP group) or a group that received saline and no hANP (N-hANP group). We measured various parameters before and after surgery using a PiCCO monitor. Result: There were no differences in the preoperative characteristics between the groups, although urine volume during the operation was significantly greater in the hANP group. After surgery, there were no significant differences between the groups in cardiac output index (CI), global enddiastolic volume index (GEDVI), intrathoracic blood volume index (ITBI), pulmonary blood volume index (PBI), extravascular lung water index (ELWI) and pulmonary vascular permeability index (PVPI), total protein, and creatine. In contrast, interleukin-6 (IL-6) and renin were significantly lower, and albumin was significantly higher in the hANP group. Conclusion: We found that low-dose hANP during open cardiac surgery inhibited the secretion and plasma activity of IL-6 and renin. Although there were no differences in lung circulatory parameters such as the amount of fluid in the pulmonary blood vessels between the two groups, we believe that the strong diuretic effect of hANP reduced third-space fluid retention caused by CPB.

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“…12 In addition to conventional cardioplegia, we also discussed the method of simultaneous bolus injection of hANP (the "hANP shot") at the time of induction of cardioplegia based on a new concept for increasing cardioprotective effects, and verified the potent myocardial protective effects in animal experiments. 15, 16 The present research is a pilot study to prove the efficacy of the "hANP shot" in clinical cases ("hANP shot" clinical trial).…”

Section: Editorial P 2052mentioning

confidence: 99%

“…Because we found that the 100-μg dose showed stronger cardioprotective effects and did not have adverse effects on the hemodynamics, a dose of 100 μg was used in this study. 15, 16 It was conducted after obtaining approval from the Ethics Committee of Nihon University School of Medicine Itabashi Hospital. Informed consent was provided by each patient after they received an explanation about the study.…”

Section: Study Protocolmentioning

confidence: 99%

Myocardial Protective Effect of Human Atrial Natriuretic Peptide in Cardiac Surgery - "hANP Shot" in Clinical Safety Trial -

Sezai

Wakui

Akiyama

et al. 2011

Circ J

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Background:We studied low-dose human atrial natriuretic peptide (hANP) infusion therapy during cardiac surgery and reported the cardiac and renal protective effects. The efficacy of a bolus injection of hANP (the "hANP shot") simultaneously with induction of cardioplegia has been proven in animal experiments. In the present study the clinical effects of this "hANP shot" were examined. Methods and Results:The subjects were 67 patients undergoing Coronary artery bypass grafting. At the time of inducing cardioplegia, 1 group received a simultaneous bolus injection of 100 μg of hANP (hANP group) and the other group received an injection of physiological saline (placebo group). The primary endpoints were (1) operative mortality and complications, and (2) the creatine kinase isoenzyme MB (CPK-MB), troponin-I, and human heart fatty acid binding protein (H-FABP) levels. The secondary endpoints were (1) the incidence of arrhythmia, and levels of (2) atrial and B-type natriuretic peptides, and cyclic guanosine monophosphate (cGMP), and (3) renin, angiotensin II, and aldosterone. Postoperative CPK-MB, troponin-I, and H-FABP levels were significantly lower in the hANP group than in the placebo group. Postoperative arrhythmia was significantly less frequent in the hANP group than in the placebo group. Conclusions:It is possible to achieve cardioprotective effects based on the safety of the "hANP shot", as well as from biomarkers of ischemia and results related to arrhythmia. The "hANP shot" should also be evaluated as a safer and new cardioprotective method for cardiac surgery. (Circ J 2011; 75: 2144 - 2150

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Experimental investigation of direct myocardial protective effect of atrial natriuretic peptide in cardiac surgery

Cited by 13 publications

References 25 publications

Results of Emergency Coronary Artery Bypass Grafting for Acute Myocardial Infarction: Importance of Intraoperative and Postoperative Cardiac Medical Therapy

Results of Emergency Coronary Artery Bypass Grafting for Acute Myocardial Infarction: Importance of Intraoperative and Postoperative Cardiac Medical Therapy

Effects of Continuous Infusion of Low-dose Human Atrial Natriuretic Peptide (hANP) on the Lungs during Cardiac Surgery

Myocardial Protective Effect of Human Atrial Natriuretic Peptide in Cardiac Surgery - "hANP Shot" in Clinical Safety Trial -

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