Administration of brain natriuretic peptide improves cardiac function following operations using the extracorporeal circulation in an animal model
Résumé
The critical phase during cardiosurgical procedures is weaning the diseased heart from extracorporeal circulation. Postischemic heart failure sometimes requires the administration of inotropic and/or vasconstrictive agents. The natriuretic peptides influence pre- and afterload through their natriuretic, diuretic and vasodilating actions. To date, there are only few informations concerning the therapeutic effect of brain natriuretic peptide administration during cardiosurgical procedures. The goal of this study was to evaluate the effect of brain natriuretic peptide (BNP) administration following extracorporeal circulation in an animal model. Surgery was performed on twenty swine using extracorporeal circulation. A 30-minute ischemic episode was simulated. Following declamping, BNP was administered to the BNP group (n=10) by an IV bolus at 0.3 microgram/kg/min followed by an infusion at a rate of 0.015 microgram/kg/min for 60 minutes. The animals in the control group (n=10) did not receive BNP, but instead a saline solution. Hemodynamic and clinical chemistry parameters as well as the amount of catecholamines that were required were documented. All of the animals in the BNP group had a significantly better cardiac output and cardiac index at the end of the experiment. Seven out of 10 animals from the control group needed catecholamines, whereas only one animal from the BNP group did. Creatine phosphokinase levels were significantly lower in the BNP group. Systemic vascular resistance was markedly lower in the BNP group. Administration of BNP is highly effective in treating post-ischemic heart failure following extracorporeal circulation. Hemodynamics are greatly improved, and there is almost no need for pharmacological support.
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