Abstract 17242: Effects of Tolvaptan on Early Outcomes for Patients Undergoing Cardiac Surgery and Predictors for its Responders
Introduction: The efficacy of tolvaptan, a vasopressin V2 receptor antagonist, on refractory fluid retention after cardiac surgery is unknown. The aim of this study was to investigate the safety and efficacy of tolvaptan for fluid retention resistant to loop diuretics and predictors for responders after cardiac surgery.
Methods: Between March 2014 and February 2016, 105 patients who underwent cardiac surgery in our hospital received tolvaptan 7.5mg orally in addition to furosemide 40mg because of remaining fluid retention. The beginning and duration of administration of tolvaptan was postoperative day 5.4±4.4 and 1.6±0.8 days, respectively. The responder to tolvaptan was defined as urine output of more than 2000 / 4000ml for 24 / 48 hours or body weight reduction of more than 0.5 / 1 kg for 24 / 48 hours after the administration. Early outcomes were compared between responders and non-responders. The predictors for responders were analyzed using multivariate logistic regression.
Results: There were 70 responders to tolvaptan (67%). Pre- and intraoperative variables, and the beginning and duration of administration of tolvaptan were almost the same between responders and non-responders. Reduction of body weight (BW) after administration was significantly higher in responders, compared to that in non-responders (-1.8 kg vs -0.6 kg, p< 0.0001). There was tendency towards shorter durations to return to preoperative BW (10.4±5.7 days vs 12.7±6.9 days, p= 0.10) and to discharge (22.5±11.0 days vs 27.4±16.7 days, p= 0.13) in responders. The increase in the value of serum sodium significantly higher in responders. Tolvaptan did not affect hemodynamic status nor renal function in both groups ndependent predictors for responders were the values of blood urea nitrogen; ≦27 mg/dL (p< 0.0001, OR; 10.2), serum sodium; ≦140 mEq/L (p= 0.001, OR; 5.1), serum albumin; ≦3.4 g/dL (p= 0.02, OR; 3.8) and the increase in BW after surgery; ≧1.3 kg (p= 0.02, OR; 3.2). Every parameter was obtained just before the administration.
Conclusions: Tolvaptan is safe, and effective in 67% of patients with refractory fluid retention after cardiac surgery. Early administration of tolvaptan might be helpful in postoperative management if the patients meet those four predictors for responders.
Author Disclosures: K. Morimoto: None. S. Numata: None. S. Yamazaki: None. K. Itatani: None. H. Kawajiri: None. S. Ohira: None. H. Yaku: None.
- © 2016 by American Heart Association, Inc.