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. Design: Randomized, prospective study. Settings: University hospital. Participants: Thirty-four patients with preoperative LVEF ≤0.4 undergoing elective cardiac surgery. Interventions: 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 (D2), and group C did not receive ACE-Is. In both groups, the withdrawal from dobutamine started at D3. Measurements and Main Results: NT-BNP levels were determined before (T0), immediately after surgery (T1), and on the next 4 days (T2, T3, T4, and T5). 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 T5. This increase was more pronounced in group C (p = 0.037 and 0.008 at T3 and T4, 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.