B-type natriuretic peptide therapy in total artificial heart implantation: Renal effects with early initiation

Abstract

B-type natriuretic peptide (BNP) is produced mainly by ventricular myocytes and to a lesser degree by cardiac fibroblasts. 1 Hall C. Essential biochemistry and physiology of (NT-pro) BNP. Eur J Heart Fail. 2004; 6: 257-260 Crossref PubMed Scopus (390) Google Scholar In the context of end-stage heart failure, chronic myocyte stretch upregulates BNP and intracellular cyclic GMP synthesis, thus inducing vasodilation, diuresis and inhibition of the renin–aldosterone system. In the case of total artificial heart (TAH) implantation, resection of the native ventricles results in a rapid decrease of endogenous BNP production and interruption of these signaling pathways. Consequently, renal function declines. 2 Delgado R. Wadia Y. Kar B. et al. Role of B-type natriuretic peptide and effect of nesiritide after total cardiac replacement with the AbioCor total artificial heart. J Heart Lung Transplant. 2005; 24: 1166-1170 Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar Low-dose BNP infusions have been proven to have a positive impact on urine output in the early post-operative setting. 3 Shah K.B. Tang D.G. Kasirajan V. et al. Impact of low-dose B-type natriuretic peptide infusion on urine output after total artificial heart implantation. J Heart Lung Transplant. 2012; 31: 670-672 Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar However, due to the lack of large-study experience, optimal timing of BNP therapy is still unclear. Because prevalence of chronic renal failure in TAH candidates is high, 4 Sarraf M. Masoumi A. Schrier R.W. Cardiorenal syndrome in acute decompensated heart failure. Clin J Am Soc Nephrol. 2009; 4: 2013-2016 Crossref PubMed Scopus (137) Google Scholar we hypothesized that early initiation of low-dose BNP infusion therapy in all patients would help avoid low urine output events 3 Shah K.B. Tang D.G. Kasirajan V. et al. Impact of low-dose B-type natriuretic peptide infusion on urine output after total artificial heart implantation. J Heart Lung Transplant. 2012; 31: 670-672 Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar and diminish the need for renal replacement therapy.