Postoperative treatment with angiotensin-converting enzyme inhibitors in patients with preoperative reduced left ventricular systolic function.
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.
Villacorta
Judith
J
Département d'Anesthésie-Réanimation, CHU Timone Adultes Marseille, Marseille, France.
Oddoze
Chistiane
C
Giorgi
Roch
R
Kerbaul
François
F
Bonnet
Marc
M
Collart
Frédéric
F
Gouin
François
F
Guidon
Catherine
C
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
D000806:Angiotensin-Converting Enzyme Inhibitors