• Judith Villacorta, Chistiane Oddoze, Roch Giorgi, François Kerbaul, Marc Bonnet, Frédéric Collart, François Gouin, and Catherine Guidon.
• Département d'Anesthésie-Réanimation, CHU Timone Adultes Marseille, Marseille, France.
• J. Cardiothorac. Vasc. Anesth. 2008 Apr 1; 22 (2): 187-91.

ObjectiveThe 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) DesignRandomized, prospective study.SettingsUniversity hospital.ParticipantsThirty-four patients with preoperative LVEF InterventionsPatients 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).Measurements And Main ResultsNT-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.ConclusionsACE-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.

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