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J Thorac Cardiovasc Surg 1995;110:1600-1605
© 1995 Mosby, Inc.

CARDIAC AND PULMONARY REPLACEMENT

ATRIAL NATIURETIC PEPTIDE RELEASE AT REST AND WITH EXERCISE AFTER CARDIAC TRANSPLANTATION WITH BICAVAL ANASTOMOSES

Kiel, Germany

From the Clinic of Cardiovascular Surgery, University of Kiel, Kiel, Germany.

Received for publication June 2, 1994. Accepted for publication April 12, 1995. Address for reprints: H H. Sievers, PhD, Medizinische Universität zu Lübeck, Klinik für Herzchirurgie, 23562 Lübeck, Ratzeburger Allee 160.

Abstract

Bicaval anastomoses in orthotopic cardiac transplantation offer the advantage of preserving the right atrial geometry. To elucidate the impact of this anastomotic technique on atrial natriuretic peptide plasma levels at rest and with exercise, nine patients were submitted to a symptom-limited supine exercise test. Atrial natriuretic peptide plasma levels in samples obtained from the right atrium were elevated at rest (274.4±60.4 pg/ml), at peak exercise (438.1±71.7 pg/ml), and thereafter (328.1±71.2 pg/ml) with respect to normal reference values of 21±1 pg/ml at rest and 92±14 at peak exercise. Renin, angiotensin, and aldosterone plasma levels were almost normal and did not indicate any pathologic processes in volume homeoostasis. Right-sided hemodynamic parameters were not correlated with atrial natriuretic peptide secretion. An adverse relationship between cold ischemic time of the donor organ and atrial natriuretic peptide release was found (r = 0.88, p <0.0008), indicating that endocrine cardiocytes are sensitive to prolonged ischemia. Atrial natriuretic peptide release may thus be independent of the surgical approach, and other unique characteristics of the transplanted heart, such as denervation, are more likely to be responsible for elevated atrial natriuretic peptide plasma concentrations after orthotopic heart transplantation. (J THORAC CARDIOVASC SURG 1995;110:1600-5)

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