Beneficial hemodynamic and renal effects of intravenous enalaprilat following coronary artery bypass surgery complicated by left ventricular dysfunction*

Wagner, Frank; Yeter, R.; Bisson, S.; Siniawski, Henryk; Hetzer, Roland

doi:10.1097/01.ccm.0000063050.66813.39

Cited by 32 publications

(16 citation statements)

References 37 publications

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“…They found that administration of intravenous ACE inhibitor improved the renal perfusion by counteracting the renin angiotensin system activity and that ACE inhibitors increased the cardiac output in patients with left ventricular dysfunction, thus, improving the renal perfusion. 3,16 The decrease in the rate of renal dysfunction that we observed in patients receiving preoperative ACE inhibitors may, therefore, be related to the protective effect of ACE inhibition on renal perfusion intra-operatively. Furthermore, preoperative ACE inhibitor therapy in the surgical population may be associated with a higher preoperative renal function reserve, making these patients less susceptible to renal injury during further CPB.…”

Section: Discussionmentioning

confidence: 99%

Is Administration of Preoperative Angiotensin-Converting Enzyme Inhibitors Important for Renal Protection after Cardiac Surgery?

et al. 2013

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Objective: There are various reasons for renal dysfunction after cardiac surgery; however, activation of the reninangiotensin system has an important role following cardiac surgery. We investigated the effect of preoperative angiotensin-converting enzyme (ACE) inhibitors on renal functions after cardiovascular surgery. Material-methods: Three hundred sixty-six patients awaiting elective cardiac surgery were allocated to two groups, namely the treatment group, comprising the ACE inhibitor group (n ¼ 186), and the control group, which was without ACE inhibitor (n ¼ 180). The renal parameters [blood urea nitrogen, creatinine, creatinine clearance, and glomerular filtration rate (GFR)] and the need for dialysis were evaluated associated with renal functions between the two groups in the postoperative period. Results: After cardiac surgery, renal dysfunction requiring dialysis developed in 11 (3.8%) patients in the control group patients. There was no required dialysis in the treatment group ( p < 0.05). As an indicator of renal dysfunction, the increase in creatinine and blood urea nitrogen levels and the decrease in GFR and creatinine clearance were higher in the control group (p < 0.05). The multivariate analysis indicated that therapy with ACE inhibitors was found to decrease the incidence of postoperative renal dysfunction (odds ratio, 1.07; 95% confidence interval, 0.45-2.50; p < 0.05). The other independent predictors were age, preoperative intra-aortic blood pump, hypertension, diabetes mellitus, and a left ventricular ejection fraction below 0.40. Conclusion: Preoperative therapy with ACE inhibitors has an influence on renal functions. This study demonstrates that administration of ACE inhibitors provides better renal protection after cardiac surgery.

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Section: Discussionmentioning

confidence: 99%

Is Administration of Preoperative Angiotensin-Converting Enzyme Inhibitors Important for Renal Protection after Cardiac Surgery?

et al. 2013

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“…35 however, at times dopamine can help to initiate diuresis when a loop diuretic alone is insufficient. although aCe-i/arB therapy should be avoided in most cases, the use of intravenous enalaprilat 36 has improved kidney performance in patients who have undergone coronary artery bypass complicated by left ventricular dysfunction. intravenous pentoxifylline in elderly patients showed a prophylactic beneficial effect on postoperative organ function, but more studies are needed to assess its efficacy; 37 moreover, this compound is not available in the united states.…”

Section: Prevention Of Post-cvs Akimentioning

confidence: 99%

Acute Kidney Injury After Cardiovascular Surgery: An Overview

Olivero

Nguyen

Kagan

2012

Methodist DeBakey Cardiovascular Journal

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Acute kidney injury is a complication of open-heart surgery that carries a poor prognosis. Studies have shown that postoperative renal function deterioration in cardiovascular surgery patients increases in-hospital mortality and adversely affects long-term survival. Identifying individuals at risk for developing AKI and aggressive early intervention is extremely important to optimize outcomes. This paper provides an overview of the etiology, prognostic markers, risk factors, and prevention of AKI and treatments that may favorably affect outcomes.

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“…This therapy also improved cardiac and stroke volume indexes and lowered pulmonary vascular resistance. 55 In observational studies, Benedetto et al 58 evaluated the effect of preoperative ACE inhibitors on acute kidney injury (AKI) in 536 patients undergoing CABG. They found that the incidence of acute kidney injury (AKI) was 6.4% in patients with ACE inhibitors but 12.2% in patients without ACE inhibitors (OR 0.48, 95% CI 0.23-0.77; Po0.04).…”

Section: )mentioning

confidence: 99%

“…Several small randomized clinical trials (n¼14-40) provide evidence that perioperative ACE inhibitor therapy improved renal blood flow and/or function in patients undergoing cardiac surgery. [55][56][57] In the postoperative intensive care unit, Wagner et al investigated the effects of enalaprilat on cardiac and renal function in patients (n¼40) with a left ventricular ejection fraction o35% following CABG. The results showed that intravenous enalaprilat increased creatinine clearance and decreased serum creatinine and urea.…”

Section: )mentioning

confidence: 99%

ACE inhibitors in cardiac surgery: current studies and controversies

2010

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Major complications associated with cardiac surgery are still common and carry great prognostic significance. Current medical interventions to prevent these cardiovascular complications include antiplatelet therapy, statins, b-blockers and angiotensinconverting enzyme (ACE) inhibitors. Both experimental studies and clinical trials have shown that ACE inhibitors hold promise as cardiovascular protective agents for cardiac surgery patients. Several lines of evidence support this hypothesis. First, long-term use of ACE inhibitors has been well established to provide cardiovascular protection and reduce ischemic events and complications, independent of their effect on heart function and blood pressure. Second, early ACE inhibitor therapy has been demonstrated to produce remarkable survival and heart function benefits in patients with acute myocardial infarction. Third, ACE blockage can prevent or delay the development or progression of renal disease at all stages, from subclinical microalbuminuria to end-stage renal disease. Nevertheless, perioperative studies of the effects of ACE inhibitors remain few and inconclusive. Results from recent clinical trials and observational studies are conflicting and raise more questions than answers. Further studies, both retrospective and larger-scale prospective studies, are critically needed to examine whether ACE inhibitors reduce mortality and major complications in patients undergoing cardiac surgery.

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Beneficial hemodynamic and renal effects of intravenous enalaprilat following coronary artery bypass surgery complicated by left ventricular dysfunction*

Abstract: Intravenous enalaprilat safely and effectively improves cardiac and renal function following coronary artery bypass surgery complicated by postoperative left ventricular dysfunction.

Cited by 32 publications

References 37 publications

Is Administration of Preoperative Angiotensin-Converting Enzyme Inhibitors Important for Renal Protection after Cardiac Surgery?

Is Administration of Preoperative Angiotensin-Converting Enzyme Inhibitors Important for Renal Protection after Cardiac Surgery?

Acute Kidney Injury After Cardiovascular Surgery: An Overview

ACE inhibitors in cardiac surgery: current studies and controversies

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