Postoperative inotropic treatment after combined beating heart coronary surgery and transmyocardial laser revascularization

Introduction

Patients with contraindications to CBP and coronary anatomy unsuitable for CABG can be treated by means of transmyocardial laser (TMLR) combined with beating heart coronary surgery. We evaluated the efficacy of enoximone (E) in improving postoperative hemodynamics.

Methods

Ten patients, mean EF 38%, undergoing the combined procedure, were randomized into two groups, one receiving E (group A, 5 patients), and one dopamine (D) (group B, 5 patients). TEE and thermodilution were performed after induction of anaesthesia (T0), after sternal closure (T1), on arrival in ICU (T2), and 12 h later (T3). Drugs were titrated in both groups until achievement of haemodynamic end points (CI > 2.6 l/min/m²; WP < 18 mmHg; TEE-EF > 35%).

Results

No differences were observed at T0 and T1 between the two groups. Group A showed a better myocardial performance than group B at T2 and T3 (EF 49 ± 9% versus 42 ± 7%, P < 0.05, and CI 3.3 ± 0.4 l/min/m² versus 2.8 ± 0.2 l/min/m², P < 0.05, at T2; EF 50 ± 8% versus 44 ± 8%, P < 0.05, and CI 3.4 ± 0.6 l/min/m² versus 3.0 ± 0.1 l/min/m², P < 0.05, at T3).

Discussion

E improves cardiac function more than D in patients undergoing combined beating heart CABG and TML revascularization. Such better haemodynamics does not affect postoperative outcome in our experience.