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Extracorporeal circulation influence on plasma atrial natriuretic peptide concentration in cardiac surgery patients
1Department of Cardiac Surgery, Kitasato University School of Medicine, Kitasato Biochemical Laboratories, Sagamihara, Japan.
Insights
During cardiac surgery with extracorporeal circulation, plasma human atrial natriuretic peptide (hANP) levels remained stable during aortic cross-clamping but surged upon release. This hANP increase is linked to rising atrial pressure.
Area of Science:
- Cardiology
- Biochemistry
- Surgical Science
Background:
- Cardiac surgery often involves extracorporeal circulation, impacting cardiac hormone levels.
- Understanding human atrial natriuretic peptide (hANP) dynamics is crucial in heart failure patients undergoing surgery.
Purpose of the Study:
- To investigate plasma hANP concentration changes during and after cardiac surgery in heart failure patients.
- To elucidate the factors influencing hANP levels during extracorporeal circulation and aortic cross-clamping.
Main Methods:
- Measurement of plasma hANP concentrations before, during, and after cardiac surgery.
- Utilizing total aortic cross-clamping (ACC) with complete vena cavae clamping.
- Employing gel permeation chromatography and reverse HPLC to determine molecular forms of hANP.
Main Results:
- Plasma hANP levels did not significantly decrease during ACC, potentially due to suppressed endopeptidase activity and receptor response at low temperatures.
- A significant increase in plasma hANP concentration was observed upon release of ACC (from 56.6 +/- 8.4 to 208.9 +/- 40.7 pg/ml).
- The primary molecular form of hANP post-ACC release was identified as alpha-hANP.
Conclusions:
- The stability of hANP during ACC may be attributed to hypothermia-induced suppression of enzymatic degradation and receptor activity.
- The substantial rise in hANP post-ACC release is likely driven by the rapid restoration of atrial pressure.
- Alpha-hANP is the predominant circulating form after reperfusion in this surgical context.
Abstract:
An attempt was made to clarify the change of plasma human atrial natriuretic peptide (hANP) concentration before, during, and after cardiac surgery in heart failure with extracorporeal circulation. Plasma hANP concentration did not significantly decrease during total aortic cross clamping (ACC) with complete clamping of the superior and inferior vena cavae. This finding may be explained by the suppression of endopeptidase activities and the response of hANP receptors due to the low body temperature. Plasma hANP concentration strongly increased from 56.6 +/- 8.4 to 208.9 +/- 40.7 pg/ml (n = 5) by the release of total ACC. This strong increase of hANP in the plasma may occur due to the rapid increase of atrial pressure from zero to 12.5 mm Hg caused by releasing the total ACC. The molecular form of plasma hANP obtained after the release of total ACC was alpha-hANP alone, which was estimated by gel permeation chromatography and reverse HPLC.