Long-term outcome of perioperative low cardiac output syndrome in cardiac surgery: 1-year results of a multicenter randomized trial.

Autor: Zangrillo A; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy., Lomivorotov VV; Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia; Novosibirsk State University, Novosibirsk, Russia., Pisano A; Division of Cardiac Anesthesia and Intensive Care Unit, AORN dei Colli - Monaldi Hospital, Naples, Italy., Calabrò MG; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy., Belletti A; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy., Brazzi L; Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza Hospital, Turin, Italy; Department of Surgical Sciences, University of Turin, Turin, Italy., Grigoryev EV; Intensive Care Unit, Scientific Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia., Guarracino F; Division of Cardiothoracic Anesthesia and Intensive Care, Department of Anesthesia and Critical Care Medicine, AOU Pisana, Pisa, Italy., Monaco F; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy., Garofalo E; Department of Anesthesia and Intensive Care, AOU Mater Domini Germaneto, Catanzaro, Italy., Crivellari M; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy., Likhvantsev VV; Department of Anesthesiology and Intensive Care, First Moscow State Medical University, Moscow, Russia; V. Negovsky Reanimatology Research Institute, Moscow, Russia., Fominskiy EV; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy., Paternoster G; Department of Anesthesia and Intensive Care, San Carlo Hospital, Potenza, Italy., Yavorovskiy A; Department of Anesthesiology and Intensive Care, First Moscow State Medical University, Moscow, Russia., Pasyuga VV; Department of Anesthesiology and Intensive Care, Federal Center for Cardiovascular Surgery Astrakhan, Astrakhan, Russia., Oriani A; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy., Lembo R; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy., Bianchi A; Department of Cardiovascular Anesthesia and Intensive Care, AO Ordine Mauriziano, Turin, Italy., Scandroglio AM; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy., Abubakirov MN; Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia., Di Tomasso N; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy., Landoni G; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. Electronic address: landoni.giovanni@hsr.it.
Jazyk: angličtina
Zdroj: Journal of critical care [J Crit Care] 2020 Aug; Vol. 58, pp. 89-95. Date of Electronic Publication: 2020 Apr 17.
DOI: 10.1016/j.jcrc.2020.04.005
Abstrakt: Purpose: Perioperative myocardial dysfunction occurs frequently in cardiac surgery, and is a risk factor for morbidity and mortality. Levosimendan has been suggested to reduce mortality of patients with perioperative myocardial dysfunction. However, long-term outcome data on its efficacy in cardiac surgery are lacking.
Materials and Methods: Cardiac surgery patients with perioperative myocardial dysfunction were randomized to levosimendan or placebo, in addition to standard inotropic care. One-year mortality data were collected.
Results: We randomized 506 patients (248 to levosimendan 258 to placebo). At 1-year follow-up, 41 patients (16.5%) died in the levosimendan group, while 47 (18.3%) died in the placebo group (absolute risk difference -1.8; 95% CI -8.4 to 4.9; P = .60). Female sex, history of chronic obstructive pulmonary disease, previous myocardial infarction, serum creatinine, hematocrit, mean arterial pressure, and duration of cardiopulmonary bypass were independently associated with 1-year mortality.
Conclusions: Levosimendan administration does not improve 1-year survival in cardiac surgery patients with perioperative myocardial dysfunction. One-year mortality in these patients is 17%. Six predictive factors for long-term mortality were identified.
Study Registration Number: NCT00994825 (ClinicalTrials.gov).
Competing Interests: Declaration of Competing Interest Dr. Fabio Guarracino received speaker fees from Amomed, Baxter, Edwards, Masimo and Orion. Dr. Valery Likhvantsev, and Dr. Vladimir V. Lomivorotov received speaker fees from Orion.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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