Skip to main content
Top
Published in: Pediatric Cardiology 8/2018

01-12-2018 | Original Article

Impact of Nesiritide Infusion on Early Postoperative Recovery After Total Cavopulmonary Connection Surgery

Authors: Yajuan Zhang, Yabing Duan, Jun Yan, Qiang Wang, Shoujun Li, Haitao Xu

Published in: Pediatric Cardiology | Issue 8/2018

Login to get access

Abstract

Objective

The purpose of the study is to compare the effects of nesiritide on the discharge time and pleural effusion in children with total cavopulmonary connection (TCPC), and to provide a more reasonable clinical method for these children.

Methods

Forty-four who children underwent cavopulmonary connection between January 2016 and 2017 were retrospectively collected, and 5 children were excluded from analysis due to postoperative thrombosis or second Fontan surgery due to high pulmonary hypertension. Thirteen children received nesiritide (3–11 days) plus conventional treatment as the nesiritide group, continuous infusion of nesiritide with the dose of 0.01 ug kg−1 min−1. Twenty-six children with the conventional treatment as the conventional treatment group. The length of stay in hospital and the retention time of chest drainage tube were compared between two groups.

Results

There were no significant differences in the time of cardiopulmonary bypass, postoperative ventilation time, ICU time, and vasoactive inotropic drug scores in the two groups. There were no hospital deaths in two groups. The median hospital stay was 20 days in the nesiritide group (11–56 days, means 25 days), and the median length of hospital stay was 28 days in the routine treatment group (9–95 days, means 34 days). There is no statistically significant difference between two groups with regard to the length of stay in hospital (P = 0.281). Regarding the thoracic drainage duration, the median was 17 days (9–55 days, means 22 days) in the nesiritide group and 23 days in the conventional treatment group (7–91 days, means 31 days) (P = 0.294). All the patients had no severe complications such as excessive fluid load, intractable hypotension, and liver or kidney injury.

Conclusion

Nesiritide is safe in children who underwent cavopulmonary connection surgery. Compared with the conventional treatment group, postoperative nesiritide is not associated with improved early clinical outcomes after TCPC surgery.
Literature
1.
go back to reference Cetta F, Feldt RH, O’Leary PW et al (1996) Improved early morbidity and mortality after Fontan operation: the Mayo Clinic experience, 1987 to 1992. J Am Coll Cardiol 28:480–486CrossRef Cetta F, Feldt RH, O’Leary PW et al (1996) Improved early morbidity and mortality after Fontan operation: the Mayo Clinic experience, 1987 to 1992. J Am Coll Cardiol 28:480–486CrossRef
2.
go back to reference Dabal RJ, Kirklin JK, Kukreja M et al (2014) The modern Fontan operation shows no increase in mortality out to 20 years: a new paradigm. J Thorac Cardiovasc Surg 148:2517–2524CrossRef Dabal RJ, Kirklin JK, Kukreja M et al (2014) The modern Fontan operation shows no increase in mortality out to 20 years: a new paradigm. J Thorac Cardiovasc Surg 148:2517–2524CrossRef
3.
go back to reference Driscoll DJ, Offord KP, Feldt RH et al (1992) Five- to fifteen-year follow-up after Fontan operation. Circulation 85:469–496CrossRef Driscoll DJ, Offord KP, Feldt RH et al (1992) Five- to fifteen-year follow-up after Fontan operation. Circulation 85:469–496CrossRef
4.
go back to reference d’Udekem Y, Iyengar AJ, Galati JC et al (2014) Redefining expectations of long-term survival after the Fontan procedure: twenty-five years of follow-up from the entire population of Australia and New Zealand. Circulation 130(11 Suppl 1):S32–S38CrossRef d’Udekem Y, Iyengar AJ, Galati JC et al (2014) Redefining expectations of long-term survival after the Fontan procedure: twenty-five years of follow-up from the entire population of Australia and New Zealand. Circulation 130(11 Suppl 1):S32–S38CrossRef
5.
go back to reference Khairy P, Fernandes SM, Mayer JE Jr et al (2008) Long-term survival, modes of death, and predictors of mortality in patients with Fontan surgery. Circulation 117:85–92CrossRef Khairy P, Fernandes SM, Mayer JE Jr et al (2008) Long-term survival, modes of death, and predictors of mortality in patients with Fontan surgery. Circulation 117:85–92CrossRef
6.
go back to reference Bartz PJ, Driscoll DJ, Dearani JA et al (2006) Early and late results of the modified Fontan operation for heterotaxy syndrome: 30 years of experience in 142 patients. J Am Coll Cardiol 48:2301–2305CrossRef Bartz PJ, Driscoll DJ, Dearani JA et al (2006) Early and late results of the modified Fontan operation for heterotaxy syndrome: 30 years of experience in 142 patients. J Am Coll Cardiol 48:2301–2305CrossRef
7.
go back to reference Jensen KT, Carstens J, Pedersen EB (1998) Effect of BNP on renal hemodynamics, tubular function and vasoactive hormones in humans. Am J Physiol 274(1 Pt 2):F63–F72PubMed Jensen KT, Carstens J, Pedersen EB (1998) Effect of BNP on renal hemodynamics, tubular function and vasoactive hormones in humans. Am J Physiol 274(1 Pt 2):F63–F72PubMed
8.
go back to reference D’Souza SP, Yellon DM, Martin C et al (2003) B-type natriuretic peptide limits infarct size in rat isolated hearts via KATP channel opening. Am J Physiol Heart Circ Physiol 284:H1592–H1600CrossRef D’Souza SP, Yellon DM, Martin C et al (2003) B-type natriuretic peptide limits infarct size in rat isolated hearts via KATP channel opening. Am J Physiol Heart Circ Physiol 284:H1592–H1600CrossRef
9.
go back to reference Kuga H, Ogawa K, Oida A, Taguchi I et al (2003) Administration of atrial natriuretic peptide attenuates reperfusion phenomena and preserves left ventricular regional wall motion after direct coronary angioplasty for acute myocardial infarction. Circ J 67:443–448CrossRef Kuga H, Ogawa K, Oida A, Taguchi I et al (2003) Administration of atrial natriuretic peptide attenuates reperfusion phenomena and preserves left ventricular regional wall motion after direct coronary angioplasty for acute myocardial infarction. Circ J 67:443–448CrossRef
11.
go back to reference Colucci WS, Elkayam U, Horton DP, Nesiritide Study Group, et al (2000) Intravenous nesiritide, a natriuretic peptide, in the treatment of decompensated congestive heart failure. N Engl J Med 343:246–253CrossRef Colucci WS, Elkayam U, Horton DP, Nesiritide Study Group, et al (2000) Intravenous nesiritide, a natriuretic peptide, in the treatment of decompensated congestive heart failure. N Engl J Med 343:246–253CrossRef
12.
go back to reference Mentzer RM Jr, Oz MC, Sladen RN et al (2007) Effects of perioperative nesiritide in patients with left ventricular dysfunction undergoing cardiac surgery: the NAPA Trial. J Am Coll Cardiol 49:716–726CrossRef Mentzer RM Jr, Oz MC, Sladen RN et al (2007) Effects of perioperative nesiritide in patients with left ventricular dysfunction undergoing cardiac surgery: the NAPA Trial. J Am Coll Cardiol 49:716–726CrossRef
13.
go back to reference Seghaye MC, Duchateau J, Bruniaux J et al (1997) Endogenous nitric oxide production and atrial natriuretic peptide biological activity in infants undergoing cardiac operations. Crit Care Med 25:1063–1070CrossRef Seghaye MC, Duchateau J, Bruniaux J et al (1997) Endogenous nitric oxide production and atrial natriuretic peptide biological activity in infants undergoing cardiac operations. Crit Care Med 25:1063–1070CrossRef
14.
go back to reference Costello JM, Backer CL, Checchia PA et al (2005) Effect of cardiopulmonary bypass and surgical intervention on the natriuretic hormone system in children. J Thorac Cardiovasc Surg 130:822–829CrossRef Costello JM, Backer CL, Checchia PA et al (2005) Effect of cardiopulmonary bypass and surgical intervention on the natriuretic hormone system in children. J Thorac Cardiovasc Surg 130:822–829CrossRef
15.
go back to reference Sun LS, Dominguez C, Mallavaram NA et al (2005) Dysfunction of atrial and B-type natriuretic peptides in congenital univentricular defects. J Thorac Cardiovasc Surg 129:1104–1110CrossRef Sun LS, Dominguez C, Mallavaram NA et al (2005) Dysfunction of atrial and B-type natriuretic peptides in congenital univentricular defects. J Thorac Cardiovasc Surg 129:1104–1110CrossRef
16.
go back to reference Stewart JM, Gewitz MH, Clark BJ et al (1991) The role of vasopressin and atrial natriuretic factor in postoperative fluid retention after the Fontan procedure. J Thorac Cardiovasc Surg 102:821–829PubMed Stewart JM, Gewitz MH, Clark BJ et al (1991) The role of vasopressin and atrial natriuretic factor in postoperative fluid retention after the Fontan procedure. J Thorac Cardiovasc Surg 102:821–829PubMed
17.
go back to reference Hiramatsu T, Imai Y, Takanashi Y et al (1999) Time course of endothelin-1 and adrenomedullin after the Fontan procedure. Ann Thorac Surg 68:169–172CrossRef Hiramatsu T, Imai Y, Takanashi Y et al (1999) Time course of endothelin-1 and adrenomedullin after the Fontan procedure. Ann Thorac Surg 68:169–172CrossRef
18.
go back to reference Mainwaring RD, Lamberti JJ, Carter TL et al (1995) Renin, angiotensin II, and the development of effusions following bidirectional Glenn and Fontan procedures. J Card Surg 10:111–118CrossRef Mainwaring RD, Lamberti JJ, Carter TL et al (1995) Renin, angiotensin II, and the development of effusions following bidirectional Glenn and Fontan procedures. J Card Surg 10:111–118CrossRef
19.
go back to reference Takata Y, Hirayama Y, Kiyomi S et al (1996) The beneficial effects of atrial natriuretic peptide on arrhythmias and myocardial high-energy phosphates after reperfusion. Cardiovasc Res 32:286–293CrossRef Takata Y, Hirayama Y, Kiyomi S et al (1996) The beneficial effects of atrial natriuretic peptide on arrhythmias and myocardial high-energy phosphates after reperfusion. Cardiovasc Res 32:286–293CrossRef
20.
go back to reference O’Connor CM, Starling RC, Hernandez P et al (2011) Effect of nesiritide in patients with acute decompensated heart failure. N Engl J Med 365(1):32–43CrossRef O’Connor CM, Starling RC, Hernandez P et al (2011) Effect of nesiritide in patients with acute decompensated heart failure. N Engl J Med 365(1):32–43CrossRef
21.
go back to reference Mahle WT, Cuadrado AR, Kirshbom PM et al (2005) Nesiritide in infants and children with congestive heart failure. Pediatr Crit Care Med 6:543–546CrossRef Mahle WT, Cuadrado AR, Kirshbom PM et al (2005) Nesiritide in infants and children with congestive heart failure. Pediatr Crit Care Med 6:543–546CrossRef
22.
go back to reference Simsic JM, Scheurer M, Tobias JD et al (2006) Perioperative effects and safety of nesiritide following cardiac surgery in children. J Intensive Care Med 21:22–26CrossRef Simsic JM, Scheurer M, Tobias JD et al (2006) Perioperative effects and safety of nesiritide following cardiac surgery in children. J Intensive Care Med 21:22–26CrossRef
23.
go back to reference Jefferies JL, Price JF, Denfield SW et al (2007) Safety and efficacy of nesiritide in pediatric heart failure. J Card Fail 13:541–548CrossRef Jefferies JL, Price JF, Denfield SW et al (2007) Safety and efficacy of nesiritide in pediatric heart failure. J Card Fail 13:541–548CrossRef
24.
go back to reference Simsic JM, Mahle WT, Cuadrado A, Kirshbom PM et al (2008) Hemodynamic effects and safety of nesiritide in neonates with heart failure. J Intensive Care Med 23:389–395CrossRef Simsic JM, Mahle WT, Cuadrado A, Kirshbom PM et al (2008) Hemodynamic effects and safety of nesiritide in neonates with heart failure. J Intensive Care Med 23:389–395CrossRef
25.
go back to reference Costello JM, Dunbarmasterson C, Allan CK et al (2014) Impact of empiric nesiritide or milrinone infusion on early postoperative recovery after Fontan surgery: a randomized, double-blind, placebo-controlled trial. Circ Heart Fail 7:596–604CrossRef Costello JM, Dunbarmasterson C, Allan CK et al (2014) Impact of empiric nesiritide or milrinone infusion on early postoperative recovery after Fontan surgery: a randomized, double-blind, placebo-controlled trial. Circ Heart Fail 7:596–604CrossRef
Metadata
Title
Impact of Nesiritide Infusion on Early Postoperative Recovery After Total Cavopulmonary Connection Surgery
Authors
Yajuan Zhang
Yabing Duan
Jun Yan
Qiang Wang
Shoujun Li
Haitao Xu
Publication date
01-12-2018
Publisher
Springer US
Published in
Pediatric Cardiology / Issue 8/2018
Print ISSN: 0172-0643
Electronic ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-018-1935-3

Other articles of this Issue 8/2018

Pediatric Cardiology 8/2018 Go to the issue

Images in Pediatric Cardiology

An Unusual Electrocardiogram