Practical application of human B-type natriuretic peptide as a therapeutic intervention in the perioperative setting

The use of human B-type natriuretic peptide (BNP, nesiritide) as a therapeutic intervention is now well established for patients with acute decompensated heart failure. Nesiritide mimics the actions of endogenous BNP by binding to and stimulating receptors in the heart, kidney, and vasculature. Postsurgical patients are typically managed with various combinations of vasodilators, diuretics, and inotropes. Many of these therapeutic interventions lack significant proof of efficacy and are potentially deleterious to these patients, despite the acute hemodynamic improvement that results from their use. Use of nesiritide may supplant some of these therapies as an equally efficacious and possibly safer alternative in patients with decompensated heart failure. Nesiritide is a unique, balanced vasodilator that markedly decreases the signs and symptoms of heart failure in perioperative patients, and also may decrease the need for inotropic agents. This review summarizes nesiritide's mechanism of action and addresses special concerns and practical considerations for cardiothoracic surgeons and anesthesiologists. Overall, nesiritide appears to be an effective and safe therapeutic option in perioperative patients with decompensated heart failure.