Sustained use of nesiritide to aid in bridging to heart transplant

Patients with end-stage heart failure awaiting heart transplant are often maintained on continuous intravenous inotropic therapy. However, this therapy alone is often inadequate for maintenance of appropriate pulmonary artery pressure and stable clinical course. Nesiritide, B-type natriuretic peptide, is a recently released intravenous vasodilator for short-term use in patients with decompensated heart failure. This report details experience in four patients in whom this agent was used to bridge to transplant for prolonged periods (11-35 days) with added clinical benefit and without obvious tolerance. This suggests that new strategies for pretransplant management may be needed.