Efficacy of Tolvaptan in Patients with Volume Overload after Cardiac Surgery

Authors

  • Kenichiro Noguchi Aorta Center and Surgery, Shonankamakura General Hospital, Kamakura City, Kanagawa
  • Masashi Tanaka Aorta Center and Surgery, Shonankamakura General Hospital, Kamakura City, Kanagawa
  • Ikuo Katayama Aorta Center and Surgery, Shonankamakura General Hospital, Kamakura City, Kanagawa
  • Tsuyoshi Yamabe Aorta Center and Surgery, Shonankamakura General Hospital, Kamakura City, Kanagawa
  • Daisuke Yuji Aorta Center and Surgery, Shonankamakura General Hospital, Kamakura City, Kanagawa
  • Norikazu Oosiro Aorta Center and Surgery, Shonankamakura General Hospital, Kamakura City, Kanagawa
  • Miyo Sirouzu Aorta Center and Surgery, Shonankamakura General Hospital, Kamakura City, Kanagawa

DOI:

https://doi.org/10.1532/hsf.1470

Abstract

Background: The vasopressin type 2 receptor antagonist tolvaptan (TLV) has recently become available for treating congestion. However, there is no evidence confirming the efficacy of TLV for patients with volume overload after cardiac surgery. Here, we retrospectively studied the efficacy of TLV in patients with volume overload after cardiac surgery.
Methods: We enrolled a total of 39 patients who had volume overload after cardiac surgery and who were treated with our protocol of body fluid management. The primary endpoint of this study was to evaluate the hospitalization period, while the secondary endpoints were to estimate adverse events such as hypotension, electrolyte abnormality, presence or absence of renal dysfunction and liver damage, and the incidence of atrial fibrillation (AF).
Results: The hospitalization period of the T (TLV) and C (furosemide and spironolactone) groups was 12.3 ± 2.6 days and 14.7 ± 4.4 days, respectively (P = .044), the mean urine volume was 2761.5 ± 850.3 mL/day and 2205.2 ± 598.5 mL/day, respectively (P = .024), and the incidence of postoperative AF after diuretics administration was 2/19 (11%) and 9/17 (52%), respectively.
Conclusion: TLV successfully and rapidly improved organ congestion without causing hemodynamic abnormalities (hypotension, arrhythmia development), electrolyte abnormality, liver damage or renal dysfunction, thus significantly reducing the period of hospitalization.

References

Adams KF Jr, Fonarow GC, Emerman CL, et al. 2005. ADHERE Scientific Advisory Committee and Investigators. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J 149:209-16.

Almassi GH, Schowalter T, Nicolosi AC, Aggarwal A, Moritz TE, Henderson WG. 1997. Atrial fibrillation after cardiac surgery: a major morbid event? Ann Surg 226:501-13.

Dohi K, Ito M. 2014. Novel diuretic strategies for the treatment of heart failure in Japan. Circ J 78:1816-23.

Hakala T, Hedman A. 2003. Predicting the risk of atrial fibrillation after coronary artery bypass surgery. Scand Cardiovasc J 37:309-15.

Hirleman E, Larson DF. 2008. Cardiopulmonary bypass and edema: physiology and pathophysiology. Perfusion 23:311-22.

Li L, Bai H, Zhu WL. 2011. Tolvaptan therapy in hyponatremia with heart failure collaborative group. The efficacy and safety of tolvaptan on treating heart failure patients with hyponatremia. Zhonghua Xin Xue Guan Bing Za Zhi 39:936-40.

Matsuzaki M, Hori M, Izumi T, Fukunami M. Tolvaptan Investigators. 2011. Efficacy and safety of tolvaptan in heart failure patients with volume overload despite the standard treatment with conventional diuretics: a phase III, randomized, double-blind, placebo-controlled study (QUEST study). Cardiovasc Drugs Ther 25 Suppl 1:S33-45.

Peacock WF, Emerman C, Costanzo MR, Diercks DB, Lopatin M, Fonarow GC. 2009. Early vasoactive drugs improve heart failure outcomes. Congest Heart Fail 15:256-64.

Sahin I, Ozkaynak B, Karabulut A, et al. 2014. Impact of coronary collateral circulation and severity of coronary artery disease in the development of postoperative atrial fibrillation. Interact Cardiovasc Thorac Surg 19:394- 7.

Udelson JE, Bilsker M, Hauptman PJ, et al. 2011. A multicenter, randomized, double-blind, placebo-controlled study of tolvaptan monotherapy compared to furosemide and the combination of tolvaptan and furosemide in patients with heart failure and systolic dysfunction. J Card Fail 17:973-81.

Wuerz RC, Meador SA. 1992. Effects of prehospital medications on mortality and length of stay in congestive heart failure. Ann Emerg Med 21:669-74.

Yamamura Y, Nakamura S, Itoh S, et al. 1998. OPC-41061, a highly potent human vasopressin V2-receptor antagonist: pharmacological profile and aquaretic effect by single and multiple oral dosing in rats. J Pharmacol Exp Ther 287:860-7.

Published

2015-11-24

How to Cite

Noguchi, K., Tanaka, M., Katayama, I., Yamabe, T., Yuji, D., Oosiro, N., & Sirouzu, M. (2015). Efficacy of Tolvaptan in Patients with Volume Overload after Cardiac Surgery. The Heart Surgery Forum, 18(6), E232-E236. https://doi.org/10.1532/hsf.1470

Issue

Section

Articles

Most read articles by the same author(s)