Copyright © 1992 by the European Society of Cardiology.
© 1992 The European Society of Cardiology
Enoximone, a post-operative inodilator in patients following mitral valve operation: a prospective and controlled study
Department of Thoracic and Cardiovascular Surgery, Hannover Medical School Germany
*Department of Cardiology, Hannover Medical School Germany
Received 14 February 1991; revised 14 June 1991; .
Correspondence Dr med. Bernard Hausen, Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Konstanty-Gutschow Str.6, 3000 Hannover 61, Germany.
Abstract
lno tropic support is often required for post-operative management of patients following mitral valve operation. The use of positive inotropes is limited by tolerance development and increase in myocardial oxygen demand. We have compared i. v. enoximone (E) (group E, n=13), a recently developed phosphodiesterase (PDE) inhibitor, to the conventional i.v. therapeutics dopamine (D) and glyceroltrinitrate (G) in patients following mitral valve operation. The two groups were comparable in terms of physical and pre-operative haemodynamic data. Haemodynamic measurements including cardiac index (CI) determinations were recorded for the first 18 h post surgery in both groups. Group E received a bolus of lmg.kg–1 E followed by 4–20 µg. kg–1. min–1 (mean = 5±2µg.kg–1.min–1) for 14 h according to therapeutic requirements, while group D received dopamine (4–10µg. kg–1. min–1, mean = 3.8±1.9 µg. kg–1. min–1) and glyceroltrinitrate (0.5–5 µg.kg–1, min–1; mean = 4±2 µg. kg–1. min–1). Adrenaline was added if the MAP was below 60mmHg or the CI was below 2–5 in both groups (range 50–500ng. kg–1. min–1; mean E=0–7±2ng. kg–1. min–1; mean D = 2±2–8ng. kg–1. min–1).
Bolus injection of E resulted in a rise in Cl from 2–6 to 3–21. min–1. m–2 (P<0.05) within 30 min, followed by a further rise to a maximum of 3.51. min–1. m–2 6 hpost bolus. Termination of the E drip resulted in a drop of CI to baseline values (P<0–05). In group D the CI constantly decreased from 3.7 to 3.01. min–1. m–2 (P<0–05) despite the fact that seven of 13 patients received additional adrenaline (versus two in group E; P < 0.05). The mean arterial pressure in group E dropped after bolus injection from 74 mmHg to 68 mmHg followed by a constant rise to a maximum of 84 mmHg by the end of the study. The systemic vascular resistance index (SVRI) decreased from 700 to 500 dynes.s–1. cm–5. m–2 in group E, while in group D the SVRI increased from 500 at baseline to 780 dynes.s–1. cm–5.m–2 at the end of the study (MANOVA P<0.05). The left and right cardiac work index, as indirect parameters of oxygen consumption, did not significantly increase in group E when compared to group D. Enoximone did not cause serious side effects. The clinical outcome of both groups was identical and there were no deaths. It is concluded that monotherapy with enoximone can replace dopamine and glyceroltrinitrate (plus moderate adrenaline) after mitral valve operation, with increased cardiac output and decreased systemic vascular resistance.
Key Words: Phosphodiesterase inhibitors • intensive care therapy postcardiectomy • inodilators • positive inotropy • enoximone • mitral valve operation
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