Efficacy of Tolvaptan in Older Adults Undergoing Cardiac Surgery: A Single-Center Retrospective Analysis

• Published in: Revista brasileira de cirurgia cardiovascular 2024-11, Vol.e20230507 (e20230507)
• Main Authors: Chen, Lin, Zhou, Min, Lv, Dingliang, Qiu, Shuiwei
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Antidiuretic Hormone Receptor Antagonists - therapeutic use; Cardiac Surgical Procedures; Female; Humans; Length of Stay; Male; Postoperative Complications; Retrospective Studies; Tolvaptan - therapeutic use; Treatment Outcome
• ISSN: 1678-9741; 1678-9741
• DOI: 10.21470/1678-9741-2023-0507

Globally, cardiovascular diseases remain a predominant cause of mortality. Effective fluid management is particularly critical in older adults undergoing cardiac surgery, due to their heightened risk of postoperative complications. Tolvaptan, an oral vasopressin V2 receptor antagonist, has emerged as a promising agent for fluid regulation in cardiac patients. However, its efficacy in the elderly undergoing cardiac surgery is not thoroughly evaluated. This single-center retrospective analysis included 146 older adults (≥ 65 years) who underwent cardiac surgery between January 2018 and December 2022. Patients were categorized into two groups: those receiving tolvaptan and a control group receiving traditional diuretics post-surgery. We assessed several outcomes, including hospital length of stay, 30-day mortality, postoperative renal function, and complications. The study found a significantly reduced hospitalization duration in the tolvaptan group (P=0.044), with no escalation in adverse events. The tolvaptan cohort exhibited a considerable increase in urine output on the postoperative day (POD) three (P=0.003), indicating enhanced renal function and fluid management. Serum creatinine levels notably declined by POD3 (P=0.012), and blood urea nitrogen levels were appreciably lower by POD5 (P