Advent of New perioperative care for fluid management after cardiovascular surgery: A review of current evidence

• Published in: Journal of cardiology 2020-06, Vol.75 (6), p.606-613
• Main Author: Nishi, Hiroyuki
• Format: Article
• Language: English
• Subjects: Cardiovascular surgery; Heart failure; Postoperative fluid management; Renal function; Tolvaptan
• ISSN: 0914-5087; 1876-4738
• DOI: 10.1016/j.jjcc.2019.12.010

•Tolvaptan has a new potential for postoperative management after cardiac surgery.•Tolvaptan can be used safely in the postoperative period after cardiovascular surgery.•The incidence of worsening renal function is significantly lower when tolvaptan is used.•Tolvaptan is beneficial in patients with decreased renal function, and increased body weight.•Tolvaptan provides fluid removal without affecting renal function and serum sodium concentration. Fluid management with diuretics is a key factor for postoperative management following cardiovascular surgery, and it is common to administer intermittent doses of diuretics and fluids in the early postoperative stage as primary therapy. Loop diuretics are usually given as the first option, followed by an aldosterone blocker, mannitol, and human atrial natriuretic peptide (hANP) or recombinant human B-type natriuretic peptide infusion. Although the effects of tolvaptan, a new type of diuretic with an aquaretic effect to increase urine volume without increasing electrolyte excretion into urine by blocking the vasopressin V2 receptor, on congestive heart failure are well known, it has not been established whether advantages may also be recognized in the volume overload in early postoperative stage after cardiac surgery. In this review, we clarified the efficacy of tolvaptan as the advent of new fluid management after cardiovascular surgery. Tolvaptan has advantageous effects for immediate body weight reduction in patients with positive postoperative water balance following cardiac surgery. This immediate volume reduction could help recovery of respiratory dysfunction due to lung edema. Also, hypernatremia was rarely seen; therefore, it can be used safely during postoperative period. With regard to the response of tolvaptan, it seemed to have a beneficial effect in patients with decreased renal function, increased body weight, and hypoalbuminemia. Although long-term outcome is still unknown, tolvaptan treatment added to conventional diuretics treatment in patients undergoing cardiovascular surgery provides sufficient amount of fluid removal without affecting renal function and serum sodium concentrations, and reduced the incidence of worsening renal function.