Postoperative treatment with angiotensin-converting enzyme inhibitors in patients with preoperative reduced left...

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)

Randomized, prospective study.

University hospital.

Thirty-four patients with preoperative LVEF

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).

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.

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.