TY - JOUR

T1 - Long-term outcome of perioperative low cardiac output syndrome in cardiac surgery

T2 - 1-year results of a multicenter randomized trial

AU - CHEETAH Study Group

AU - Zangrillo, Alberto

AU - Lomivorotov, Vladimir V.

AU - Pisano, Antonio

AU - Calabrò, Maria Grazia

AU - Belletti, Alessandro

AU - Brazzi, Luca

AU - Grigoryev, Evgeny V.

AU - Guarracino, Fabio

AU - Monaco, Fabrizio

AU - Garofalo, Eugenio

AU - Crivellari, Martina

AU - Likhvantsev, Valery V.

AU - Fominskiy, Evgeny V.

AU - Paternoster, Gianluca

AU - Yavorovskiy, Andrey

AU - Pasyuga, Vadim V.

AU - Oriani, Alessandro

AU - Lembo, Rosalba

AU - Bianchi, Alessandro

AU - Scandroglio, A. Mara

AU - Abubakirov, Marat N.

AU - Di Tomasso, Nora

AU - Landoni, Giovanni

N1 - Publisher Copyright: © 2020 Elsevier Inc.

PY - 2020/8/1

Y1 - 2020/8/1

N2 - 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).

AB - 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).

KW - Cardiac surgery

KW - Catecholamines

KW - Hemodynamic management

KW - Levosimendan

KW - Low-cardiac output syndrome

KW - Mortality

UR - http://www.scopus.com/inward/record.url?scp=85087321324&partnerID=8YFLogxK

U2 - 10.1016/j.jcrc.2020.04.005

DO - 10.1016/j.jcrc.2020.04.005

M3 - Article

C2 - 32402931

AN - SCOPUS:85087321324

VL - 58

SP - 89

EP - 95

JO - Journal of critical care

JF - Journal of critical care

SN - 0883-9441

ER -