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J Thorac Cardiovasc Surg 2004;128:627-629
© 2004 The American Association for Thoracic Surgery

Brief communication

Nesiritide as an adjunctive therapy in adult patients with heart failure undergoing high-risk cardiac surgery

Louis E. Samuels, MDa,*, Elena C. Holmes, CRNPa, Lee Letwin, MDb

a Department of Cardiothoracic Surgery, Lankenau Hospital, Wynnewood, Pa, USA
b Department of Cardiothoracic Anesthesia, Lankenau Hospital, Wynnewood, Pa, USA

Received for publication February 9, 2004; accepted for publication February 23, 2004.

* Address for reprints: Louis E. Samuels, MD, MCP Hahnemann University, Department of Cardiothoracic Surgery 245 N 15th St, Mail Stop 111, Philadelphia, PA 19102-1192, USA
SamuelsLE@aol.com

The first 20% of the full text of this article appears below.

The use of nesiritide has been shown to be efficacious in patients with decompensated heart failure.1 The role of nesiritide in cardiac surgery, however, remains undetermined. The purpose of this report is to document our initial experience with nesiritide as an adjunctive therapy in adult patients with heart failure undergoing high-risk cardiac surgery.

Patients and methods

Between October 2003 and January 2004, a total of 12 patients with advanced heart failure underwent cardiac surgery by a single surgeon at a single center. The use of nesiritide was determined by 4 intraoperative criteria: (1) congestive heart failure (New York Heart Association functional class III-IV), (2) pulmonary hypertension (systolic pulmonary arterial pressure [PAP] >40 mm Hg), (3) low cardiac index (CI. <2.0 L/[min · m2]), and (4) elevated central venous pressure (CVP, >15 mm Hg). Patients with and without renal insufficiency were included. Nesiritide was instituted as an infusion (0.1 µg/[kg · min]) after placement of a Swan-Ganz catheter (Edwards Lifesciences, Irvine, Calif). The infusion was continued after the operation until the desired hemodynamic state was established. Other cardiac medications were administered as needed to augment cardiac output (eg, . . . [Full Text of this Article]






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