Mauriat Philippe, Bojan Mirela, Soulie Sylvie, Foulgoc Hélène, Tafer Nadir, Ouattara Alexandre
Department of Anaesthesia and Critical Care, University of Bordeaux, Haut-Levêque Hospital, Avenue Magellan, 33000, Pessac, France.
Department of Anaesthesia, Congenital Cardiac Unit, Marie-Lannelongue Hospital, Paris-Sud University, 133 Avenue de la Résistance, 92350, Le Plessis-Robinson, France.
Ann Intensive Care. 2020 Jul 9;10(1):91. doi: 10.1186/s13613-020-00709-0.
Grown-up congenital heart (GUCH) patients represent a growing population with a high morbidity risk when undergoing reparative surgery. A main preoperative feature is right ventricular failure, which represents a risk factor for postoperative low cardiac output syndrome. Levosimendan has a potentially beneficial effect. This retrospective study included consecutive GUCH patients with surgeries in a tertiary cardiothoracic centre between 01-01-2013 and 01-10-2017, to test the hypothesis that the postoperative use of levosimendan might be associated with shorter time of mechanical ventilation, when compared with the use of milrinone. To adjust for bias related to the probability of treatment assignment, it uses the inverse propensity score weighting methodology.
Overall 363 patients had GUCH surgeries during the study period, their mean age was 31.39 ± 15.31 years, 87 patients were eligible for analysis in the Levosimendan group and 117 in the Milrinone group. The propensity score used pre- and intraoperative variables and resulted in a good balance between covariates. The Levosimendan group included patients with higher preoperative risk scores, a higher prevalence of left and right ventricular failure, who required more often the addition of epinephrine, renal replacement therapy, prolonged mechanical ventilation and intensive care stay. However, after propensity score weighting, patients in the Levosimendan group had shorter durations of mechanical ventilation (average treatment effect - 37.59 h IQR [- 138.85 to - 19.13], p = 0.01) and intensive care stay (average treatment effect - 3.11 days IQR [- 10.03 to - 1.48], p = 0.009). The number of days of additional epinephrine support was shorter and the vasoactive inotropic scores lower.
We report a beneficial effect in terms of duration of mechanical ventilation and intensive care stay, and on inotropic requirements of the use of levosimendan following GUCH surgeries. The use of levosimendan in this setting requires validation at a larger scale.
成人生存期先天性心脏病（GUCH）患者数量不断增加，接受修复手术时发病风险较高。术前的一个主要特征是右心室衰竭，这是术后低心排血量综合征的一个危险因素。左西孟旦可能具有有益作用。这项回顾性研究纳入了2013年1月1日至2017年10月1日期间在一家三级心胸中心接受手术的连续性GUCH患者，以检验与使用米力农相比，术后使用左西孟旦可能与机械通气时间缩短相关的假设。为了校正与治疗分配概率相关的偏倚，研究采用了逆倾向评分加权方法。
在研究期间，共有363例患者接受了GUCH手术，他们的平均年龄为31.39±15.31岁，87例患者符合左西孟旦组分析条件，117例患者符合米力农组分析条件。倾向评分使用术前和术中变量，使协变量之间达到了良好的平衡。左西孟旦组患者术前风险评分较高，左、右心室衰竭的患病率较高，更常需要加用肾上腺素、进行肾脏替代治疗、延长机械通气时间和加强护理。然而，在倾向评分加权后，左西孟旦组患者的机械通气时间（平均治疗效果-37.59小时，IQR[-138.85至-19.13]，p=0.01）和加强护理时间（平均治疗效果-3.11天，IQR[-10.03至-1.48]，p=0.009）较短。额外使用肾上腺素支持的天数较短，血管活性药物评分较低。
我们报告了左西孟旦在GUCH手术后机械通气时间、加强护理时间以及肌力需求方面具有有益作用。在这种情况下使用左西孟旦需要更大规模的验证。
