Comparison of enoximone and piroximone in patients after mitral valve operation: a prospective and controlled clinical study.
Phosphodiesterase III (PDEII) inhibitors as so-called inodilators have previously proven a valuable alternative to positive inotropes in patients with cardiac insufficiency. In this study we compared patients receiving piroximone (P, n = 14, 0.5-mg/kg bolus in 30 min and then 3-6 micrograms/kg/min) with enoximone patients (E, n = 13, 1-mg/kg bolus and then 4-20 micrograms/kg/min) and with a third group (D, n = 14) receiving a combination of dopamine (4-10 micrograms/kg/min) and glyceroltrinitrate (0.5-5 micrograms/kg/min) for hemodynamic support. All three groups were comparable in terms of age, body surface area, and preoperative cardiac function [cardiac index (CI) less than or equal to 2.5 L/min/m2, LAP greater than 15 mm Hg]. Hemodynamic measurements (10) and Holter monitoring were performed until 18 h post MVR. In all groups, epinephrine was used for additional inotropic therapy if mean arterial pressure (MAP) was less than 60 mm Hg and/or CI was less than 2.5 L/min/m2. There was no early or late postoperative mortality in either group. Continuous support with epinephrine was necessary in 8 patients in group D, whereas initially 8 patients in group E and 6 patients in group P required epinephrine support. After PDE III inhibitor infusion, 2 patients in group E and 2 patients in group P remained epinephrine dependent (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Hausen
B
B
Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Germany.
Heublein
B
B
Vogelpohl
J
J
von der Leyen
H
H
Haverich
A
A
D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D004298:Dopamine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004562:Electrocardiography / Q000187:drug effects; D017335:Enoximone; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D005996:Nitroglycerin / Q000627:therapeutic use; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D011182:Postoperative Care; D011446:Prospective Studies; D016276:Ventricular Function / Q000187:drug effects
D002316:Cardiotonic Agents; D007093:Imidazoles; D010726:Phosphodiesterase Inhibitors; C039686:piroximone; D017335:Enoximone; D005996:Nitroglycerin; D004298:Dopamine; D004837:Epinephrine