|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
|
|
|
|||||||||
|
|||||||||||
|
J Am Coll Cardiol, 2007; 49:716-726, doi:10.1016/j.jacc.2006.10.048
(Published online 8 December 2006). © 2007 by the American College of Cardiology Foundation |
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
* Division of Cardiothoracic Surgery, Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan
Division of Cardiothoracic Surgery, College of Physicians & Surgeons, Columbia University, New York, New York
Department of Anesthesiology, College of Physicians & Surgeons, Columbia University, New York, New York
MultiCare Cardiothoracic Surgical Associates, Tacoma General Hospital, Tacoma, Washington
|| Department of Surgery, Baylor University Medical Center, Dallas, Texas
¶ Franciscan Health System Research Center, Tacoma, Washington
# Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic, Cleveland, Ohio.
Manuscript received August 1, 2006; revised manuscript received September 26, 2006, accepted October 12, 2006.
* Reprint requests and correspondence: Dr. Robert M. Mentzer, Jr., Wayne State University School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, 1241 Scott Hall, 540 E. Canfield, Detroit, Michigan 48201. (Email: rmentzer{at}med.wayne.edu).
Objectives: The purpose of this study was to determine the role nesiritide might play in patients with left ventricular dysfunction undergoing coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB).
Background: Given the hemodynamic, neurohormonal, and renal effects of natriuretic peptides, nesiritide might be useful in the management of patients undergoing cardiac surgery.
Methods: This prospective, double-blind, exploratory evaluation randomly assigned patients with ejection fraction 
40% who were undergoing CABG with anticipated use of CPB to receive either nesiritide or placebo, in addition to usual care, for 24 to 96 h after induction of anesthesia. Postoperative renal function, hemodynamics, and drug use (primary end points) were assessed in patients who underwent CABG using CPB; mortality and safety (secondary end points) were assessed in all patients who received the study drug.
Results: Of 303 randomized patients, 279 received the study drug and 272 underwent CABG using CPB. Compared with placebo, nesiritide was associated with a significantly attenuated peak increase in serum creatinine (0.15 ± 0.29 mg/dl vs. 0.34 ± 0.48 mg/dl; p < 0.001) and a smaller fall in glomerular filtration rate (–10.8 ± 19.3 ml/min/1.73 m2 vs. –17.2 ± 21.9 ml/min/1.73 m2; p = 0.001) during hospital stay or by study day 14, and a greater urine output (2,926 ± 1,179 ml vs. 2,350 ± 1,066 ml; p < 0.001) during the initial 24 h after surgery. In addition, nesiritide-treated patients had a shorter hospital stay (p = 0.043) and lower 180-day mortality (p = 0.046).
Conclusions: Nesiritide in the setting of CABG with CPB is associated with improved postoperative renal function and possibly enhanced survival. (The NAPA Trial; http://www.clinicaltrials.gov/ct/show; NCT00090792 [ClinicalTrials.gov] )
| |||||||||||
Related Article
J. Am. Coll. Cardiol. 2007 49: 727-728.
This article has been cited by other articles:
|
|
 |
|
  G. Cote and A. Denault Transesophageal echocardiography-related complications: [Complications associees a l'echocardiographie transoesophagienne] Can J Anesth, September 1, 2008; 55(9): 622 - 647. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Ryan, D. A. Rosen, and J. D. Tobias Preliminary Experience With Nesiritide in Pediatric Patients Less Than 12 Months of Age J Intensive Care Med, September 1, 2008; 23(5): 321 - 328. [Abstract] [PDF]
|
|
|
|
 |
|
 A. S. Stewart, M. J. Russo, T. P. Martens, T. M. Naseem, M. C. Deng, R. Wang, M. Argenziano, M. Oz, and Y. Naka Longer duration of continuous-flow ventricular assist device support predicts greater hemodynamic compromise after return of pulsatility. J. Thorac. Cardiovasc. Surg., August 1, 2008; 136(2): 524 - 525. [Full Text] [PDF]
|
|
|
|
 |
|
 J. R. Brown, R. P. Cochran, T. A. MacKenzie, A. P. Furnary, K. S. Kunzelman, C. S. Ross, C. W. Langner, D. C. Charlesworth, B. J. Leavitt, L. J. Dacey, et al. Long-term survival after cardiac surgery is predicted by estimated glomerular filtration rate. Ann. Thorac. Surg., July 1, 2008; 86(1): 4 - 11. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O. Lisy, B. K. Huntley, D. J. McCormick, P. A. Kurlansky, and J. C. Burnett Jr Design, Synthesis, and Actions of a Novel Chimeric Natriuretic Peptide: CD-NP. J. Am. Coll. Cardiol., July 1, 2008; 52(1): 60 - 68. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. M. Beaver, A. Bihorac, and A. A. Ejaz Reply to the Editor: J. Thorac. Cardiovasc. Surg., July 1, 2008; 136(1): 233 - 233. [Full Text] [PDF]
|
|
|
|
 |
|
 J. C. Burnett Jr and J. Korinek The Tumultuous Journey of Nesiritide: Past, Present, and Future Circ Heart Fail, May 1, 2008; 1(1): 6 - 8. [Full Text] [PDF]
|
|
|
|
|
|
C. W. Yancy, H. Krum, B. M. Massie, M. A. Silver, L. W. Stevenson, M. Cheng, S. S. Kim, R. Evans, and for the FUSION II Investigators Safety and Efficacy of Outpatient Nesiritide in Patients With Advanced Heart Failure: Results of the Second Follow-Up Serial Infusions of Nesiritide (FUSION II) Trial Circ Heart Fail, May 1, 2008; 1(1): 9 - 16. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Herget-Rosenthal, F. Saner, and L. S. Chawla Approach to Hemodynamic Shock and Vasopressors Clin. J. Am. Soc. Nephrol., March 1, 2008; 3(2): 546 - 553. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Kazory and E. A. Ross Contemporary Trends in the Pharmacological and Extracorporeal Management of Heart Failure: A Nephrologic Perspective Circulation, February 19, 2008; 117(7): 975 - 983. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. N. DeMaria, J. J. Bax, O. Ben-Yehuda, P. Clopton, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, J. D. Knoke, W. Y.W. Lew, J. A.C. Lima, et al. Highlights of the year in JACC 2007. J. Am. Coll. Cardiol., January 29, 2008; 51(4): 490 - 512. [Full Text] [PDF]
|
|
|
|
|
|
M. A. Silver and C. W. Yancy Using Homeostatic Peptides in Decompensated Heart Failure: A Reasonable Paradigm But a Flawed Practice? J. Am. Coll. Cardiol., November 6, 2007; 50(19): 1841 - 1843. [Full Text] [PDF]
|
|
|
|
|
|
R. M. Witteles, D. Kao, D. Christopherson, K. Matsuda, R. H. Vagelos, D. Schreiber, and M. B. Fowler Impact of Nesiritide on Renal Function in Patients With Acute Decompensated Heart Failure and Pre-Existing Renal Dysfunction: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial J. Am. Coll. Cardiol., November 6, 2007; 50(19): 1835 - 1840. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. L. Martin, T. Supaporn, H. H. Chen, S. M. Sandberg, Y. Matsuda, M. Jougasaki, and J. C. Burnett Jr. Distinct roles for renal particulate and soluble guanylyl cyclases in preserving renal function in experimental acute heart failure Am J Physiol Regulatory Integrative Comp Physiol, October 1, 2007; 293(4): R1580 - R1585. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. H. Chen, T. M. Sundt, D. J. Cook, D. M. Heublein, and J. C Burnett Jr Low Dose Nesiritide and the Preservation of Renal Function in Patients With Renal Dysfunction Undergoing Cardiopulmonary-Bypass Surgery: A Double-Blind Placebo-Controlled Pilot Study Circulation, September 11, 2007; 116(11_suppl): I-134 - I-138. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Dunn and S. Sachak Nesiritide and renal function after cardiac surgery Am. J. Health Syst. Pharm., August 1, 2007; 64(15): 1582 - 1584. [Full Text] [PDF]
|
|
|
|
|
|
I. Belenkie Nesiritide Administration in Patients With Left Ventricular Dysfunction Undergoing Coronary Artery Bypass Surgery J. Am. Coll. Cardiol., February 13, 2007; 49(6): 727 - 728. [Full Text] [PDF]
|
|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
