Effects of Perioperative Recombinant Human Brain Natriuretic Peptide in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis.

BACKGROUND

Clinical trials have demonstrated the efficacy of recombinant human brain natriuretic peptide (rhBNP) in managing acute decompensated heart failure. Moreover, since rhBNP performs roles in hemodynamic regulation, neurohormonal balance, and renal function, rhBNP administration could benefit cardiac surgery patients. We conducted a systematic review and meta-analysis to evaluate the impact of perioperative rhBNP in cardiac surgery patients.

METHODS

We conducted a comprehensive search of the MEDLINE, Embase, the Cochrane Library, CNKI, and WANFANG databases from January 1, 2007, until December 31, 2023, identifying randomized controlled trials (RCTs) that examined the use of rhBNP during cardiac surgery. We estimated the treatment effects of perioperative rhBNP administration using a random-effects meta-analysis. The primary cardiovascular endpoint was the change in left ventricular ejection fraction (LVEF); meanwhile, renal function was assessed using the 24-hour urine output, changes in estimated glomerular filtration rate (eGFR), and serum creatinine (SCr) levels. Additional parameters included pulmonary artery pressure (PAP), adverse event (AE) incidence, respiratory support duration, ICU length of stay (ICU LOS), hospital length of stay (hospital LOS), and tumor necrosis factor-α (TNF-α) levels.

RESULTS

Our meta-analysis included 38 RCTs encompassing 2280 patients. The use of rhBNP in the perioperative period significantly enhanced LVEF compared to the control group (mean difference = 3.13 (95% CI [1.88, 4.37]; p < 0.00001). Additionally, rhBNP administration was associated with a significant increase in the 24-hour urine volume (mean difference = 401.42, 95% CI [253.06, 549.77]; p < 0.00001) and an improvement in eGFR (mean difference = 13.94, 95% CI [5.57, 22.31]; p = 0.001). Meanwhile, perioperative administration of rhBNP significantly reduced SCr levels (mean difference = -14.55, 95% CI [-22.04, -7.06]; p < 0.0001). In addition, rhBNP significantly decreased PAP, the incidence of AEs, the duration of respiratory support, ICU LOS, hospital LOS, and TNF-α levels.

CONCLUSIONS

These findings underscore the potential benefits of rhBNP as a perioperative treatment in patients undergoing cardiac surgery.