Preoperative prevention of heart failure in noncardiac surgery

Abstract

Congestive heart failure is consistently associated with adverse outcomes, and is characterized by a twofold increase in mortality in non-cardiac surgery. In this regard, developing the methods aimed to prevent and treat acute heart failure (AHF) in the intraoperative period remain a challenging problem. Objective. To evaluate the efficacy of preoperative levosimendan infusion in reduction both mortality and duration of treatment of elderly patients with reduced left ventricular ejection fraction in non-cardiac surgery. Material and Methods. Design: Multicenter blind randomized placebo-controlled study. Patients: 81 patients operated on abdominal organs. The main endpoint of the study: The length of stay in the Intensive Care Unit (ICU) and at the hospital were chosen as the primary endpoints. The secondary endpoints of the study were 30-day and annual mortality, the rate of acute myocardial infarction and stroke. Results. Levosimendan infusion at a rate of 0,05 μg/kg/min - 0,1 μg/kg/min to patients with low left ventricular ejection fraction just before the surgery reduced the length of stay in ICU for 2 days and required hospital stay for 3 days. NT-proBNP showed the best ratio of sensitivity/specificity in predicting 30-day mortality in cumulative group: AUC=0,86 (90,77 to 0,93), P<0,0001. From other indicators the most informative were the Inotropes scoring, no change or decrease of a left ventricular ejection fraction, and cardiac index. Conclusion. To reduce perioperative mortality, the intravenous infusion of levosimendan at a rate of 0,05-0,1 μg/kg/min in elderly patients with low left ventricular ejection fraction is recommened as a preoperative preparation the day before the alleged non-cardiac surgery.