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Angiotensin Converting Enzyme Inhibitors and Cardiopulmonary Bypass: Is ACE Inhibitor Safe for Heart Surgery?

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Ischemia/reperfusion injury is unavoidable during cardiopulmonary bypass surgery because the surgery is conducted during ischemic arrest of the heart. Animal studies have shown that the administration of angiotensin converting enzyme (ACE) inhibitors can protect against lethal arrhythmias, preserve ventricular function, and improve coronary reserve after ischemia/reperfusion. Two factors to consider when using ACE inhibitors are their temperature dependency (because cardiopulmonary bypass surgery is usually done under hypothermic conditions) and their direct effect on the bypass material.

In this paper, we review studies of ACE inhibitors and discuss both their temperature dependency and their effect on bypass material, especially on the coating of the circuit tube and artificial lung. Finally, we explore the potential clinical applications of ACE inhibitors in cardiopulmonary bypass surgery, taking into consideration the findings of our own preliminary clinical study.
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Keywords: ace inhibitor; angiotensin; biocompatibility; bradykinin; cardiopulmonary bypass; heart surgery; review

Document Type: Review Article

Affiliations: Department of Cardiovascular Surgery, Yuri Kumiai General Hospital, 38, Yago, Ienoato, Yuri-Honjo, AKITA 015-8511 Japan.

Publication date: 01 November 2005

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  • Current Enzyme Inhibition aims to publish all the latest and outstanding developments in enzyme inhibition studies with regards to the mechanisms of inhibitory processes of enzymes, recognition of active sites, and the discovery of agonists and antagonists, leading to the design and development of new drugs of significant therapeutic value. Each issue contains a series of timely, in-depth reviews written by leaders in the field, covering a range of enzymes that can be exploited for drug development. Current Enzyme Inhibition is an essential journal for every pharmaceutical and medicinal chemist who wishes to have up-to-date knowledge about each and every development in the study of enzyme inhibition.
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