title: Postoperative treatment with angiotensin-converting enzyme inhibitors in patients with preoperative reduced left ventricular systolic function.
abstract: OBJECTIVE
  The utility of angiotensin-converting enzyme inhibitors (ACE-Is) as early substitutes for dobutamine was studied after cardiac surgery in patients with preoperative left ventricular ejection fraction (LVEF) </=0.4.
  
  
  METHODS
  Randomized, prospective study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Thirty-four patients with preoperative LVEF </=0.4 undergoing elective cardiac surgery.
  
  
  METHODS
  Patients were prospectively randomized into 2 groups before the operation. Group R patients treated with ACE-Is received ramipril, 1.25 mg twice a day, from the day after the operation (D(2)), and group C did not receive ACE-Is. In both groups, the withdrawal from dobutamine started at D(3).
  
  
  RESULTS
  NT-BNP levels were determined before (T(0)), immediately after surgery (T(1)), and on the next 4 days (T(2), T(3), T(4), and T(5)). Creatinine values were recorded before surgery, at the second day, and at the discharge from the intensive care unit. In both groups, baseline NT-BNP levels were high, although not significantly different, and increased postoperatively until T(5). This increase was more pronounced in group C (p = 0.037 and 0.008 at T(3) and T(4)(,) respectively). ACE-Is were well tolerated in all patients in group R.
  
  
  CONCLUSIONS
  ACE-Is can be used as a dobutamine substitute as early as the first postoperative day after cardiac surgery without renal consequences. Ramipril was beneficial in patients with left ventricular dysfunction as shown by NT-BNP levels that were lower in group R.
authors: Département d'Anesthésie-Réanimation, CHU Timone Adultes Marseille, Marseille, France.
authors: Judith
authors: J
authors: Villacorta
authors: Chistiane
authors: C
authors: Oddoze
authors: Roch
authors: R
authors: Giorgi
authors: François
authors: F
authors: Kerbaul
authors: Marc
authors: M
authors: Bonnet
authors: Frédéric
authors: F
authors: Collart
authors: François
authors: F
authors: Gouin
authors: Catherine
authors: C
authors: Guidon
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors