Results of mitral valve surgery for secondary regurgitation with poor left ventricular function

Background and aim: Surgical repair of secondary mitral regurgitation is still controversial especially when the cardiac function is reduced. The purpose of this study was to retrospectively investigate the operative and long-term results of mitral valve surgery for secondary mitral valve regurgitation with poor cardiac function. Risk factors for long-term mortality were also investigated. Methods Patients with preoperative echocardiographic left ventricular ejection fraction ≤30% who underwent mitral valve surgery due to secondary mitral regurgitation comprised the study group. Cardiac function and valve regurgitation was assessed with echocardiogram using modifiled Simpson’s method and color-flow Doppler. Peri-operative results and long-term survival were investigated. Results Sixty-nine patients (mean age 65.5 years, 58 males) with secondary mitral regurgitation and poor left ventricular function comprised the study group, and their early results were investigated; long-term results were evaluated in 66 cases. There were no operative/in-hospital deaths. Postoperative echocardiograms showed significantly improved mitral regurgitation, from moderate to severe to less than trivial (p<0.001), although poor left ventricular function remained. Actual 1-, 3-, and 5-year survival rates were 90.5%, 76.5%, and 63.4%, respectively. The 1-, 3-, and 5-year re-admission-free rates due to heart failure were 74.6%, 61.6%, and 55.3%, respectively. Patients with clinical frailty scale scores ≥4 had a worse prognosis than patients with clinical frailty scale scores <4 (log-rank p=0.046). Conclusions Open mitral valve surgery could be appropriate for secondary mitral valve regurgitation with poor cardiac function, however, operative indications should be considered carefully in patients with high clinical frailty scale scores.

Comparison of Levosimendan Versus IABP in Patients with Poor Left Ventricular Function Undergoing Coronary Artery Bypass Graft Surgery

Objectives: The aim of this study was to compare the use of levosimendan versus intra-aortic balloon pump (IABP) in patients with poor left ventricular function undergoing coronary artery bypass grafting (CABG) with ejection fraction less than 35%. Methods: Between February 2016 and March 2019, a prospective randomized study was performed on a group of 279 consecutive patients with left ventricular ejection fraction < 35%, who underwent elective CABG without concomitant procedures. These patients were divided into 2 groups, according to the treatment they received – either levosimendan (Group A) or intra-aortic balloon counterpulsation (Group B). Results: There was no statistically significant difference between the 2 groups, regarding mortality and morbidity. In the IABP group, the mean arterial blood pressure (2 hours post cardiopulmonary bypass) significantly was higher, and the heart rate in postoperative Day 1 significantly was lower. The levosimendan group had a significantly lower ICU stay than the IABP group. Conclusion: We found that starting levosimendan infusion after induction of anesthesia is an acceptable option in comparison to IABP. The use of levosimendan in high-risk cardiac patients is comparable to IABP in improving hemodynamics during and after conventional on-pump CABG and results in a shorter ICU stay.

Effect of Levosimendan Compared to Conventional Inotropic Agents on Hemodynamics and Outcome in Patient with Poor LV Function Undergoing Cardiac Surgery

BACKGROUND: Patients undergoing heart surgery involving cardiopulmonary bypass (CPB) experience global myocardial ischemia with subsequent reperfusion which, despite cardioplegic protection, may result in different degrees of transient ventricular dysfunction. Levosimendan is a “calcium sensitisers”, it improves myocardial contractility by sensitising troponin C to calcium without increasing myocardial oxygen consumption and without impairing relaxation and diastolic function. AIM: To evaluate the adding effect of a calcium sensitiser (levosimendan) compared to the conventional inotropic and vasoactive agent used in the patient with poor left ventricular function undergoing cardiac surgery on different measured hemodynamic variables and the effect on the outcome. METHODS: It is prospective observational studies were patients were divided into 2 groups of 30 patients each. The first Group received conventional inotropic and vasoactive treatment at different doses, while the other group received levosimendan additionally at a loading dose of 6-12mic/kg according to mean arterial pressure over 0.5 hr followed by 24 hrs infusion at 0.05 to 0.2 mic/kg/min. Hemodynamic data were collected at the end and 30 minutes after CPB, after that at 6, 12, 24, and 36 hours post CPB. Mean arterial pressure (MAP), central venous pressure (CVP), heart rate (HR), mixed venous saturation (Svo2), and base deficit (BD) were measured. RESULTS: Levosimendan had significantly improved postoperative hemodynamic values as in the mixed venous pressure at different times postoperative (p < 0.05), also the base deficit at different times postoperative (p < 0.05), while there was a significant reduction in systemic vascular resistance as decreased mean arterial pressure in levosimendan group compared to conventional group at 6hrs postoperative mean 77.50 ± 10.81 vs 83.73 ± 10.81 with (p = 0.029), and at 12 hrs postoperative mean 77.37 ± 10.10vs 84.23 ± 13.81 with (p = 0.032), and there was no significant difference in heart rate at different times postoperative between both groups (p > 0.05), while there was no significant effect on mortality between both groups (p = 0.781). CONCLUSION: Levosimendan had improved hemodynamic parameters significantly with no effect on mortality compared to conventional inotropic agents in a patient with poor left ventricular function undergoing cardiac surgery.