Early introduction of tolvaptan after cardiac surgery: a renal sparing strategy in the light of the renal resistive index measured by ultrasoundReport as inadecuate

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Journal of Cardiothoracic Surgery

, 10:143

First Online: 02 November 2015Received: 01 July 2015Accepted: 28 October 2015


BackgroundRenal failure is a serious complication after cardiac surgery, which can be caused by long-term intravenous IV loop diuretic use. Tolvaptan is an oral selective vasopressin-2 receptor antagonist used in patients irresponsive to loop diuretics. We investigated their renal perfusion changes using the resistive index RI postoperatively.

MethodsSerial renal RI, echocardiography, and laboratory examinations from 14 patients requiring continuous postoperative IV loop diuretics were reviewed. Eight patients received tolvaptan Group T and six received oral loop diuretics before the discontinuation of IV loop diuretics Group L. The 1 data were obtained between postoperative day 0 and 2, the 2 when patients were still under IV loop diuretic treatment, the 3 after the initiation of tolvaptan or oral loop diuretic, and the 4 after the discontinuation of IV diuretics.

ResultsThe 2 RI value was higher in Group T than Group L 0.77 ± 0.09 vs. 0.69 ± 0.01, p = 0.049 but significantly decreased after tolvaptan administration 0.77 ± 0.09 to 0.65 ± 0.05 2 to 3, to 0.62 ± 0.04 to 4, both p = 0.006, while no such changes were seen in Group L. The serum sodium and albumin levels, and echo-derived tricuspid annular plane systolic excursion increased only in Group T 134.1 ± 1.5 to 138.8 ± 3.2 mEq-L, 3.3 ± 0.3 to 3.7 ± 0.5 g-dL, 16.4 ± 3.6 to 19.7 ± 4.2 mm, all p <0.05. The duration of IV loop diuretics tended to be shorter in Group T than Group L 5.6 ± 1.6 vs. 8.7 ± 3.6 days, p = 0.051.

ConclusionsAdministration of tolvaptan in patients undergoing cardiac surgery may improve their renal perfusion, as reflected by the renal RI measured using renal Doppler ultrasound.

KeywordsDiuretics Cardiac surgery Renal function Tolvaptan Renal resistive index AbbreviationsCPBcardiopulmonary bypass

eGFRestimated glomerular filtration rate

ICUintensive care unit


IVCinferior vena cava

LVEDDend-diastolic dimension

LVEFleft ventricular ejection fraction

RIresistive index

TAPSEtricuspid annular plane systolic excursion

Tomoko S. Kato and Shunya Ono contributed equally to this work.

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Author: Tomoko S. Kato - Shunya Ono - Kan Kajimoto - Kenji Kuwaki - Taira Yamamoto - Atsushi Amano

Source: https://link.springer.com/

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