***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Both atrial natriuretic peptide ( ANP ) and brain natriuretic peptide ( BNP ) bind preferentially to the natriuretic peptide A receptor . Therefore , we hypothesized that the positive inotropic and lusitropic effects of ANP might be blunted in patients with moderate congestive heart failure and high BNP levels .  Micromanometers and conductance catheters were used to obtain relatively load-insensitive left ventricular pressure-volume analysis in order to compare the myocardial and load-altering actions of ANP in 20 patients with low and high plasma BNP levels . In the low-BNP group ( plasma BNP levels < 230 pg/ml ) , ANP infusion significantly decreased end-systolic pressure and end-diastolic pressure and volume , increased end-systolic elastance , and shortened left ventricular relaxation . By contrast , in the high-BNP group ( plasma BNP levels > 230 pg/ml ) , the effect of  ANP infusion on LV contractility was blunted but its beneficial effects on LV diastolic function and LV-arterial coupling remained . Thus , ANP infusion may improve LV diastolic function even in patients with moderate heart failure and high plasma BNP levels OBJECTIVES Natriuretic peptides have been shown to improve renal blood flow and stimulate natriuresis . In a recent retrospective trial , we documented that prophylactic use of nesiritide was associated with a 66 % reduction in the odds for dialysis or in-hospital mortality at 21 days in patients undergoing high-risk cardiac surgery ; therefore , we design ed a prospect i ve trial . METHODS This prospect i ve , r and omized , clinical trial included 94 patients undergoing high-risk cardiac surgery comparing a 5-day course of continuous nesiritide ( at a dose of 0.01 microg x kg(-1 ) x min(-1 ) started before surgery ) versus placebo . The primary end point was dialysis and /or all-cause mortality within 21 days ; secondary end points were incidence of acute kidney injury , renal function , and length of stay . RESULTS Nesiritide did not reduce the primary end point of incidence of dialysis and /or all-cause mortality through day 21 ( 6.6 % vs 6.1 % ; P = .914 ) . Fewer patients receiving nesiritide had acute kidney injury ( defined as an absolute increase in serum creatinine > or = 0.3 mg/dL from baseline or a percentage increase in serum creatinine > or = 50 % from baseline within 48 hours ) compared with controls ( 2.2 % vs 22.4 % ; P = .004 ) , and mean serum creatinine was lower in the immediate postoperative period in the nesiritide group ( 1.18 + /- 0.41 mg/dL vs 1.45 + /- 0.74 mg/dL ; P = .028 ) . However , no difference in length of stay was noted ( nesiritide 20.73 + /- 3.05 days vs control 21.26 + /- 4.03 days ; P = .917 ) . CONCLUSIONS These results do not demonstrate a benefit for prophylactic use of nesiritide on the incidence of dialysis and /or death in patients undergoing high-risk cardiac surgery . Although nesiritide may provide some renal protection in the immediate postoperative period , no effect on length of stay was observed OBJECTIVES The purpose of this study was to determine the role nesiritide might play in patients with left ventricular dysfunction undergoing coronary artery bypass grafting ( CABG ) using cardiopulmonary bypass ( CPB ) .  BACKGROUND Given the hemodynamic , neurohormonal , and renal effects of natriuretic peptides , nesiritide might be useful in the management of patients undergoing cardiac surgery . METHODS This prospect i ve , double-blind , exploratory evaluation r and omly assigned patients with ejection fraction < /=40 % who were undergoing CABG with anticipated use of CPB to receive either nesiritide or placebo  , in addition to usual care , for 24 to 96 h after induction of anesthesia . Postoperative renal function , hemodynamics , and drug use ( primary end points ) were assessed in patients who underwent CABG using CPB ;  mortality and safety ( secondary end points ) were assessed in all patients who received the study drug . RESULTS Of 303 r and omized patients , 279 received the study drug and 272 underwent CABG using CPB .  Compared with placebo , nesiritide was associated with a significantly attenuated peak increase in serum creatinine ( 0.15 + /- 0.29 mg/dl vs. 0.34 + /- 0.48 mg/dl ; p < 0.001 ) and a smaller fall in glomerular filtration rate ( -10.8 + /- 19.3 ml/min/1.73 m(2 ) vs. -17.2 + /- 21.9 ml/min/1.73 m(2 ) ; p = 0.001 ) during hospital stay or by study day 14 , and a greater urine output ( 2,926 + /- 1,179 ml vs. 2,350 + /- 1,066 ml ; p < 0.001 ) during the initial 24 h after surgery . In addition , nesiritide-treated patients had a shorter hospital stay ( p = 0.043 ) and lower 180-day mortality ( p = 0.046 ) . CONCLUSIONS Nesiritide in the setting of CABG with CPB is associated with improved postoperative renal function and possibly enhanced survival . ( The NAPA Trial ; ; ) OBJECTIVES Continuous low-dose infusion of human atrial natriuretic peptide ( hANP ) in patients undergoing cardiac surgery on cardiopulmonary bypass ( CPB )  inhibits the renin-angiotensin-aldosterone system and compensates for the adverse effects of CPB . BACKGROUND We examined the influence of hANP infusion on cardiac and renal function in patients with left ventricular dysfunction undergoing coronary artery bypass grafting ( CABG ) . METHODS The subjects were 133 patients who underwent CABG and had a pre-operative ejection fraction < or = 35 % . They were r and omized to receive 0.02 microg/kg/min of hANP from the initiation of CPB ( hANP group ) or placebo ( saline ) infusion . RESULTS Early post-operative mortality did not show a significant difference between the 2 groups , but perioperative complications were significantly less frequent in the hANP group ( p = 0.015 ) . Long-term all-cause mortality showed no difference , but the cardiac death-free rate at 5 or 8 years post-operatively was 98.5 % in the hANP group and 85.5 % in the placebo group ( p = 0.0285 ) . Post-operative ejection fraction was significantly larger and the post-operative brain natriuretic peptide level was significantly lower in the hANP group . Serum creatinine was significantly lower in the hANP group than the placebo group at 1 month , 6 months , and 1 year post-operatively , whereas the estimated glomerular filtration rate was significantly higher in the hANP group at these times . CONCLUSIONS In patients with left ventricular dysfunction undergoing CABG , hANP showed renal- and cardio-protective effects and reduced post-operative complications . It also improved the long-term prognosis . We suggest that hANP should be considered as part of perioperative management of patients with cardiac dysfunction undergoing cardiac surgery . ( NU-HIT trial for LVD ; UMIN000001652 ) OBJECTIVES With the increasing use of endovascular aneurysm repair , a greater proportion of open aneurysm repairs in the future are expected to be more complex and require suprarenal cross-clamping . We sought to evaluate the effects of suprarenal ( SR ) vs infrarenal ( IR ) aortic cross-clamp position in abdominal aortic aneurysm ( AAA ) repair in an up date d single center series . METHODS All elective open AAA repairs performed at our institution between 1990 and 2006 were entered into a prospect i ve data base and review ed retrospectively . Our main stratification variable was SR vs IR . The SR group was further subdivided into those requiring an adjunctive renal revascularization procedure ( SR+RRP ; n = 54 ) and those who did not ( SR-RRP ; n = 117 ) . Univariate and multivariate models were used to analyze the effect of baseline variables and operative variables on our primary endpoint 30-day mortality as well as secondary endpoints such as major adverse events , postoperative decline in renal function ( defined as doubling of baseline creatinine to level > 2 mg/dL , or new-onset dialysis ) and long-term survival . A propensity score model was developed to control for confounding variables associated with the use of an SR cross-clamp . RESULTS A total of 1020 patients underwent elective AAA repair , of which 849 ( 83.2 % ) were IR and 171 ( 16.8 % ) were SR . Diabetes ( 14.6 % vs 9.1 % , P = .027 ) , hypertension ( 70.2 % vs 61.4 % , P = .03 ) , and chronic renal failure ( 14.0 % vs 4.7 % , P = .001 ) were more prevalent in the SR group , and mean aneurysm size was larger ( 6.0 cm vs 5.6 cm , P = .001 ) . Estimated blood loss was higher ( 1919 mL vs 1257 mL , P = .001 ) in the SR group , as was mean length of stay ( 12.6 days vs 10.7 days , P = .047 ) . Perioperative ( 30-day ) mortality rate was 1.8 % for the SR group and 1.2 % for the IR group ( P = .44 ) . Postoperative decline in renal function was 17.0 % in SR vs 9.5 % in IR ( P = .003 ) , however , new-onset dialysis was rare ( 0.6 % SR , 0.8 % IR , P = NS ) . The combination of SR+RRP was associated with an increased risk for postoperative decline in renal function ( 14.8 % SR+RRP , 4.3 % SR-RRP , P = .016 ) . Preoperative renal failure was strongly associated with postoperative renal decline ( odds ratio [ OR ] 8.15 , 2.92 - 22.8 , P < .0001 ) . Propensity score analysis demonstrated that the use of an SR cross-clamp was associated with an increased risk for postoperative renal decline ( OR 2.66 , 1.28 - 5.50 , P = .009 ) . Major adverse events were more prevalent in the SR group compared to the IR group ( 17.0 % vs 9.5 % , P = .003 ) . Five-year survival was 69.1 % + 1.9 % for the IR group and 67.7 % + 4.3 % for the SR group ( P = 0.38 ) by life table analysis . CONCLUSION Suprarenal cross-clamping is associated with low mortality and significant but acceptable morbidity , including postoperative decline in renal function . The results from this series may serve as relevant background data when evaluating emerging branched and fenestrated endograft technologies BACKGROUND We evaluated the effects of human atrial natriuretic peptide ( hANP ) during cardiopulmonary bypass ( CPB ) . METHODS Forty patients undergoing coronary artery bypass grafting were investigated . A group of patients given hANP for 24 hours from the start of CPB ( hANP group ) was compared with a non-hANP group . Parameters examined were hemodynamics , urine volume , dosage of furosemide , respiratory index , pleural effusion , ANP , cyclic guanosine monophosphate , renin activity ( renin ) , angiotensin-II , aldosterone , and glomerular filtration rate . RESULTS Central venous pressure , systemic vascular resistance index , and pulmonary vascular resistance index were significantly lower in the hANP group than in the non-hANP group . The hANP group showed significantly higher levels of ANP , cyclic guanosine monophosphate , glomerular filtration rate , and respiratory index , and significantly lower levels of renin , angiotensin-II , aldosterone , and pleural effusion , as compared with the non-hANP group . The dosage of furosemide was significantly lower and the urine volume was significantly larger in the hANP group . CONCLUSIONS hANP can satisfactorily compensate for the shortcomings of CPB by decreasing the peripheral vascular resistance , suppressing the renin-angiotensin-aldosterone system , and exerting a strong diuretic effect BACKGROUND Both preoperative left ventricular dysfunction and postoperative renal function deterioration are associated with increased long-term mortality after cardiac surgery . The influence of preoperative left ventricular dysfunction on postoperative renal dysfunction and long-term mortality is not defined . METHODS We collected data from 64 
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The infusion of ANP or BNP increased the urine output and creatinine clearance or glomerular filtration rate , and reduced the use of diuretics and the serum creatinine levels .
A meta- analysis showed that ANP infusion significantly decreased peak serum creatinine levels , incidence of arrhythmia and renal replacement therapy .
The meta- analysis also showed that ANP or BNP infusion significantly decreased the length of ICU stay and hospital stay compared with controls .
However , the combined data were insufficient to determine how ANP or BNP infusion during the perioperative period influences long-term outcome in cardiovascular surgery patients .
Conclusions The infusion of ANP or BNP may preserve postoperative renal function in cardiovascular surgery patients .