Low cardiac output syndrome after adult cardiac surgery: predictive value of peak systolic global longitudinal strain

Abstract Background The detrimental effects of inotropes are well-known, and in many fields they are only used within a goal-directed therapy approach. Nevertheless, standard management in many centers includes administering inotropes to all patients undergoing cardiac surgery to prevent low cardiac output syndrome and its implications. Randomized evidence in favor of a patient-tailored, inotrope-sparing approach is still lacking. We designed a randomized controlled noninferiority trial in patients undergoing cardiac surgery with normal ejection fraction to assess whether an dobutamine-sparing strategy (in which the use of dobutamine was guided by hemodynamic evidence of low cardiac output associated with signs of inadequate tissue perfusion) was noninferior to an inotrope-to-all strategy (in which all patients received dobutamine). Results A total of 160 patients were randomized to the dobutamine-sparing strategy (80 patients) or to the dobutamine-to-all approach (80 patients). The primary composite endpoint of 30-day mortality or occurrence of major cardiovascular complications (arrhythmias, acute myocardial infarction, low cardiac output syndrome and stroke or transient ischemic attack) occurred in 25/80 (31%) patients of the dobutamine-sparing group (p = 0.74) and 27/80 (34%) of the dobutamine-to-all group. There were no significant differences between groups regarding the incidence of acute kidney injury, prolonged mechanical ventilation, intensive care unit or hospital length of stay. Discussion Although it is common practice in many centers to administer inotropes to all patients undergoing cardiac surgery, a dobutamine-sparing strategy did not result in an increase of mortality or occurrence of major cardiovascular events when compared to a dobutamine-to-all strategy. Further research is needed to assess if reducing the administration of inotropes can improve outcomes in cardiac surgery. Trial registration ClinicalTrials.gov, NCT02361801. Registered Feb 2nd, 2015. https://clinicaltrials.gov/ct2/show/NCT02361801

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HEMODYNAMIC EFFECTS OF HYDROCORTISONE IN NEONATES WITH LOW CARDIAC OUTPUT SYNDROME AFTER CARDIAC SURGERY

Critical Care Medicine ◽

10.1097/00003246-200412001-00182 ◽

2004 ◽

Vol 32 (Supplement) ◽

pp. A49

Author(s):

Heather Dickerson ◽

Antonio R Mott ◽

Jack F Price ◽

Anthony C Chang ◽

Pertti K Suominen ◽

...

Keyword(s):

Cardiac Output ◽

Cardiac Surgery ◽

Hemodynamic Effects ◽

Low Cardiac Output Syndrome ◽

Low Cardiac Output

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Regional Blood Flow and Oxygen Transport in Patients with Low Cardiac Output Syndrome after Cardiac Surgery

Survey of Anesthesiology ◽

10.1097/00132586-199408000-00026 ◽

1994 ◽

Vol 38 (4) ◽

pp. 215

Author(s):

ESKO RUOKONEN ◽

JUKKA TAKALA ◽

AARNO KARI

Keyword(s):

Blood Flow ◽

Cardiac Output ◽

Cardiac Surgery ◽

Oxygen Transport ◽

Regional Blood Flow ◽

Low Cardiac Output Syndrome ◽

Low Cardiac Output

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Critical Illness-Related Corticosteroid Insufficiency in Patients with Low Cardiac Output Syndrome after Cardiac Surgery

The Korean Journal of Thoracic and Cardiovascular Surgery ◽

10.5090/kjtcs.2018.51.2.109 ◽

2018 ◽

Vol 51 (2) ◽

pp. 109-113 ◽

Cited By ~ 2

Author(s):

You Jung Ok ◽

Ju Yong Lim ◽

Sung-Ho Jung

Keyword(s):

Cardiac Output ◽

Cardiac Surgery ◽

Critical Illness ◽

Low Cardiac Output Syndrome ◽

Low Cardiac Output ◽

Corticosteroid Insufficiency

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Cardiovascular System

Advances in Medical Technologies and Clinical Practice - Modern Concepts and Practices in Cardiothoracic Critical Care ◽

10.4018/978-1-4666-8603-8.ch016 ◽

2015 ◽

pp. 423-450

Author(s):

Wolf Benjamin Kratzert ◽

Eva Katherine Boyd

Keyword(s):

Cardiac Arrest ◽

Cardiac Output ◽

Cardiac Surgery ◽

Pericardial Tamponade ◽

Right Ventricular Failure ◽

Orthotopic Heart Transplantation ◽

Low Cardiac Output Syndrome ◽

Future Directions ◽

Low Cardiac Output ◽

Hemodynamic State

This chapter addresses underlying physiology, diagnostics, and management of common cardiovascular abnormalities in the patient after cardiac surgery. The goal is to provide insights into daily management, areas of controversy, and future directions in the field. After reviewing basic physiologic principles of cardiac output and circulation; problems affecting the postoperative hemodynamic state will be addressed individually. Specific topics include the low cardiac output syndrome, right ventricular failure, myocardial ischemia, diastolic dysfunction, vasodilatory syndrome, rhythm disturbances, pericardial tamponade, and cardiac arrest. Patients with postoperative open chests, or after orthotopic heart transplantation are also discussed.

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P2792Preoperative levosimendan improves survival in patients with low cardiac output syndrome undergoing cardiac surgery: a meta-analysis of randomized controlled trials

European Heart Journal ◽

10.1093/eurheartj/ehz748.1107 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Brockmeyer ◽

Y Lin ◽

A Karathanos ◽

C Parco ◽

T Krieger ◽

...

Keyword(s):

Renal Failure ◽

Cardiac Output ◽

Cardiac Surgery ◽

Meta Analysis ◽

Left Ventricular ◽

Ventricular Assist Devices ◽

Left Ventricular Assist Devices ◽

Low Cardiac Output Syndrome ◽

Ventricular Assist ◽

Low Cardiac Output

Abstract Background and purpose Previous studies and meta-analyses of perioperative levosimendan to improve the outcomes of patients with low cardiac output syndrome (LCOS) undergoing cardiac surgery have given controversial results and the optimal time of infusion of levosimendan remains uncertain. We thus aimed to elucidate the risk/benefit ratio of preoperative levosimendan in a meta-analysis of randomized controlled trials (RCTs). Methods Online databases were searched for RCTs comparing preoperative levosimendan to placebo in patients with LCOS undergoing cardiac surgery until February 2019. Data from retrieved studies were abstracted and analyzed in a comprehensive meta-analysis. Primary outcome was all-cause mortality. Secondary outcomes included myocardial infarction, renal failure/replacement therapy, need for inotropic therapy, need for left ventricular assist devices, ventricular arrhythmia and arterial hypotension. Results As a result of the online database search, six eligible RCTs with 1,326 patients were included in the meta-analysis. Preoperative levosimendan showed a significant reduction in all-cause mortality (odds ratio (OR) 0.49, 95% confidence interval (CI) 0.29–0.83; p<0.01), renal failure/replacement therapy (OR 0.48, CI 0.29–0.80; p<0.01) and need for inotropic therapy (OR 0.24, CI 0.06–0.95; p=0.04) compared to placebo. There were no significant differences in levosimendan vs. placebo concerning the rates of myocardial infarction (OR 0.61, p=0.38), need for left ventricular assist devices (OR 0.38, p=0.1), ventricular arrhythmia (OR 0.7, p=0.33), and arterial hypotension (OR 1.28, p=0.07). Conclusions Preoperative administration of levosimendan may improve survival in patients with low cardiac output syndrome undergoing cardiac surgery. It reduces need for inotropic medical support and renal failure/replace-ment therapy compared to placebo.

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