Effects of angiotensin converting enzyme inhibition on systemic vascular resistance and vasoconstrictor requirements during hypothermic cardiopulmonary bypass

• Published in: European journal of cardio-thoracic surgery 1998-05, Vol.13 (5), p.546-550
• Main Authors: Deakin, Charles D., Dalrymple-Hay, Malcolm J.R., Jones, Paul, Monro, James L.
• Format: Article
• Language: English
• Subjects: ACE inhibitor; Aged; Angiotensin-Converting Enzyme Inhibitors - pharmacology; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Antihypertensive agents; Biological and medical sciences; Cardiopulmonary Bypass; Cardiovascular system; Coronary Artery Bypass; Heart Valve Prosthesis Implantation; Humans; Hypothermia, Induced; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Pilot Projects; Rewarming; Systemic vascular resistance; Vascular Resistance - drug effects; Vasoconstrictor Agents - therapeutic use
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(98)00051-7

Objective: We proposed that angiotensin converting enzyme (ACE) inhibitor therapy would alter systemic vascular resistance (SVR) during rewarming and increase the requirement for vasoactive drugs in the immediate post-bypass period. Methods: Sixty-five sequential adult patients undergoing cardiac surgical procedures requiring hypothermic (28°C) cardiopulmonary bypass (CPB) were recruited. Sixty-two fitted the inclusion criteria of which 21 were receiving ACE inhibitors prior to surgery. SVR was calculated at 1 min intervals during the rewarming phase of hypothermic CPB. The use of vasoactive drugs during and immediately after termination of CPB was recorded. The doctor administering these drugs was unaware of the nature of the study. Results: Mean SVR in the ACE group was 978 dyne/s per cm5 and in the control group was 1194 dyne/s per cm5 (P=0.006). Mean arterial pressure was 48.8 mmHg in the ACE group and 56.3 mmHg in the control group (P=0.004). There was a significant difference in vasoactive drug requirements between the groups (P