Angiotensin in cardiac surgery: efficacy in patients on angiotensin converting enzyme inhibitors

Abstract

Background: Patients presenting for cardiac surgery are often treated with angiotensin converting enzyme inhibitors Ž . Ž . ACEIs , either for heart failure or hypertension. Control of systemic vascular resistance SVR during surgery can be difficult in such patients. Angiotensin II has been available as an unlicensed vasoconstrictor, but there is concern about renal damage and its use. Aim: This study compared a standard vasoconstrictor with angiotensin II and examined the effect on renal function after cardiac surgery. Method: Twenty consecutive, consenting patients scheduled for cardiac surgery that had been taking ACEIs for at least 6 months, were randomly assigned to receive either phenylephrine or angiotensin II for the control of SVR during and for 24 h after cardiac surgery. A pulmonary artery catheter was used to guide therapy. Creatinine clearance was measured before, 24 and 48 h after surgery. Results: Low SVR and blood pressure requiring intervention was seen in all patients, particularly during cardiopulmonary bypass. One patient in the control group failed to respond to P, but responded normally to angiotensin II. Neither drug caused renal impairment. Conclusion: Angiotensin II is a safe alternative to phenylephrine in patients on ACEIs and should be considered in patients who fail to respond to conventional vasoconstrictors. ᮊ

The Use of Angiotensin II for the Treatment of Post-cardiopulmonary Bypass Vasoplegia

“…Similar were the findings of a relatively small randomized controlled clinical trial that was published in 2001 [ 10 ]. The investigators compared the efficacy of AII with phenylephrine in post-CPB patients who were taking ACEi.…”

“…Unfortunately, there is only limited data about the efficacy of AII in this patient population and these originate mostly from circumstantial case reports. Two randomized clinical trials [ 10 , 11 ], one of which was the ATHOS-3 trial, also tested the use of AII in vasoplegic patients; however, the sample sizes are too small to generate concrete conclusions. Further investigation with large-scale randomized clinical trials is deemed necessary in order to justify the use and costs of this vasopressor in cardiac surgery patients.…”

Evaluating the evidence for angiotensin II for the treatment of vasoplegia in critically ill cardiothoracic surgery patients

“…Outside of organized clinical trials, Ang-2 has been used in vasoplegic shock associated with CPB in a number of instances (Table 2). [17][18][19][20][21][22][23][24][25][26][27][28] These case reports have included a wide variety of cardiothoracic surgical procedures, including coronary revascularization with and without valve intervention, isolated valve intervention, heart transplantations, combined heart/liver transplantation, lung transplantation, pneumonectomy, left ventricular assist device insertion, and thoracoabdominal aortic aneurysm repair. [18][19][20][21][22][23][24][25][26] Reported CPB times were variable, ranging from just over an hour to upwards of 7 hours.…”

“…This agrees with findings from an earlier study examining the use of Ang-2 in patients receiving ACE 1 who required cardiothoracic surgery by Bennet and colleagues. 17 Patients were randomized to receive either Ang-2 (n ¼ 10) or phenylephrine (n ¼ 10) for low systemic vascular resistance index. All patients required vasoconstrictor support during the surgical procedure, and 1 patient who did not respond to phenylephrine received Ang-2 with good response.…”

HİPOTANSİYON TEDAVİSİ : DOĞRU BİLİNEN YANLIŞLAR ve VAZOPRESSÖR AJANLARIN GÜNCELLEMESİ

“…KC ve barsak dokusunda metabolize edilir. Hipotansiyon tedavisi (özellikle şokta) 100-200 mcg/dk infüzyon hızıyla başlanıp; azaltarak titre edilir (25).…”