Perioperative enoximone infusion improves cardiac enzyme release after CABG.
OBJECTIVE
To assess whether routine postoperative enoximone infusion compared with dobutamine improved clinical and biochemical results after coronary artery bypass grafting with cardiopulmonary bypass.


METHODS
Prospective nonrandomized study. Data collection was blinded to the choice of inotrope.


METHODS
Double-institutional clinical investigation.


METHODS
Two hundred sixteen consecutive patients undergoing myocardial revascularization between May 2000 and December 2002.


METHODS
Seventy-two patients underwent myocardial revascularization and were treated with enoximone, 5 microg/kg/min (group A). They were compared in a ratio of 1:2 to 144 patients treated with dobutamine at the same dose (group B) after aortic cross-clamp removal. The groups proved to be homogenous in preoperative and intraoperative characteristics.


RESULTS
Hospital outcome, electrocardiogram, echocardiography, further inotropic support, and biochemical markers of ischemia were compared. Subsets of patients with comorbidities and total arterial revascularization were analyzed. Perioperative myocardial infarction, postoperative low-output syndrome, intra-aortic balloon pump, atrial fibrillation, ST-segment changes, postoperative echocardiographic findings, and intensive care and hospital durations were similar between groups. In the postoperative course, more patients belonging to group A maintained low-dose inotropic support, whereas more patients belonging to group B required higher doses. Troponin I and creatine kinase-MB values were higher in patients of group B, especially when subgroups with diabetes, left ventricular hypertrophy, or total arterial revascularization were included.


CONCLUSIONS
Postoperative enoximone reduced troponin I release and need for inotropic support in patients undergoing on-pump myocardial revascularization. Subgroup data were confirmed in diabetes, left ventricular hypertrophy, and total arterial revascularization.
Onorati
Francesco
F
Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Italy. frankono@libero.it
Renzulli
Attilio
A
De Feo
Marisa
M
Galdieri
Nicola
N
Santè
Pasquale
P
Mastroroberto
Pasquale
P
Bilotta
Massimo
M
Cotrufo
Maurizio
M
D002315:Cardiopulmonary Bypass; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D001026:Coronary Artery Bypass; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D004280:Dobutamine / Q000008:administration & dosage; D004562:Electrocardiography; D017335:Enoximone / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007527:Isoenzymes / Q000097:blood; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000201:enzymology*; D011182:Postoperative Care; D011183:Postoperative Complications; D019210:Troponin I / Q000097:blood
D002316:Cardiotonic Agents; D007527:Isoenzymes; D019210:Troponin I; D004280:Dobutamine; D017335:Enoximone; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form