Perioperative enoximone infusion improves cardiac enzyme release after CABG

• Published in: Journal of cardiothoracic and vascular anesthesia 2004-08, Vol.18 (4), p.409-414
• Main Authors: Onorati, Francesco, Renzulli, Attilio, De Feo, Marisa, Galdieri, Nicola, Santè, Pasquale, Mastroroberto, Pasquale, Bilotta, Massimo, Cotrufo, Maurizio
• Format: Article
• Language: English
• Subjects: Cardiopulmonary Bypass; Cardiotonic Agents - administration & dosage; Coronary Artery Bypass; Creatine Kinase - blood; Creatine Kinase, MB Form; Dobutamine - administration & dosage; Electrocardiography; Enoximone - administration & dosage; Female; Humans; Infusions, Intravenous; inotropic drugs; Isoenzymes - blood; Male; Middle Aged; myocardial revascularization; Myocardium - enzymology; phosphodiesterase inhibitors; postcardiopulmonary bypass myocardial dysfunction; Postoperative Care; Postoperative Complications; Troponin I - blood; troponins
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2004.05.016

Objective: To assess whether routine postoperative enoximone infusion compared with dobutamine improved clinical and biochemical results after coronary artery bypass grafting with cardiopulmonary bypass. Design: Prospective nonrandomized study. Data collection was blinded to the choice of inotrope. Setting: Double-institutional clinical investigation. Participants: Two hundred sixteen consecutive patients undergoing myocardial revascularization between May 2000 and December 2002. Interventions: Seventy-two patients underwent myocardial revascularization and were treated with enoximone, 5 μg/kg/min (group A). They were compared in a ratio of 1:2 to 144 patients treated with dobutamine at the same dose (group B) after aortic cross-clamp removal. The groups proved to be homogenous in preoperative and intraoperative characteristics. Measurements and Main Results: Hospital outcome, electrocardiogram, echocardiography, further inotropic support, and biochemical markers of ischemia were compared. Subsets of patients with comorbidities and total arterial revascularization were analyzed. Perioperative myocardial infarction, postoperative low-output syndrome, intra-aortic balloon pump, atrial fibrillation, ST-segment changes, postoperative echocardiographic findings, and intensive care and hospital durations were similar between groups. In the postoperative course, more patients belonging to group A maintained low-dose inotropic support, whereas more patients belonging to group B required higher doses. Troponin I and creatine kinase—MB values were higher in patients of group B, especially when subgroups with diabetes, left ventricular hypertrophy, or total arterial revascularization were included. Conclusion: Postoperative enoximone reduced troponin I release and need for inotropic support in patients undergoing on-pump myocardial revascularization. Subgroup data were confirmed in diabetes, left ventricular hypertrophy, and total arterial revascularization.