Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Graduate School of Peking Union Medical College, Nanjing, 210008, Jiangsu, China.
Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, XuZhou Medical University, Nanjing, Jiangsu, China.
BMC Anesthesiol. 2022 May 3;22(1):135. doi: 10.1186/s12871-022-01663-z.
The purpose of the present study was to evaluate the efficacy of levosimendan in patients with acute myocardial infarction related ventricular septal rupture (AMI-VSR) underwent cardiac surgery.
Prospective observational cohort study with propensity score analysis.
There were 261 patients with AMI-VSR in our study. After 1:1 propensity matching, 106 patients (53 levosimendan and 53 control) were selected in the matched cohort.
None.
Patients who received levosimendan were assigned to the levosimendan group (n = 164). The patients who were not received were levosimendan assigned to the control group (n = 97). The levosimendan was initiated immediately after cardiopulmonary bypass. Then, it has been maintained during the postoperative 3 days. The poor outcomes were identified as follows: death and postoperative complications (postoperative stroke, low cardiac output syndromeneeded mechanical circulatory support after surgery, acute kidney injury (≥ stage III), postoperative infection or septic shock, new developed atrial fibrillation or ventricular arrhythmias).
Before matching, the control group had more length of ICU stay (6.69 ± 3.90 d vs. 5.20 ± 2.24 d, p < 0.001) and longer mechanical ventilation time (23 h, IQR: 16-53 h vs. 16 h, IQR: 11-23 h, p < 0.001). Other postoperative outcomes have not shown significant differences between two groups. After matching, no significant difference was found between both groups for all postoperative outcomes. The Kaplan-Meier survivul estimate and log-rank test showed that the 90-day survival had no significant differences between two groups before and after matching.
Our study found that a low-dose infusion of levosimendan in AMI-VSR patients underwent surgical repair did not associated with positively affect to postoperative outcomes.
本研究旨在评估左西孟旦在接受心脏手术的急性心肌梗死相关室间隔破裂（AMI-VSR）患者中的疗效。
前瞻性观察队列研究与倾向评分分析。
本研究共纳入 261 例 AMI-VSR 患者。经过 1:1 倾向评分匹配后，在匹配队列中选择了 106 例患者（53 例左西孟旦和 53 例对照组）。
无。
接受左西孟旦的患者被分配到左西孟旦组（n=164）。未接受左西孟旦的患者被分配到对照组（n=97）。左西孟旦在心外膜旁路后立即开始使用，然后在术后 3 天内维持使用。不良结局定义为：死亡和术后并发症（术后卒中、低心输出综合征需要术后机械循环支持、急性肾损伤（≥III 期）、术后感染或感染性休克、新发心房颤动或室性心律失常）。
在匹配前，对照组的 ICU 住院时间（6.69±3.90 d 比 5.20±2.24 d，p<0.001）和机械通气时间（23 h，IQR：16-53 h 比 16 h，IQR：11-23 h，p<0.001）更长。两组的其他术后结局无显著差异。匹配后，两组的所有术后结局均无显著差异。Kaplan-Meier 生存估计和对数秩检验显示，匹配前后两组的 90 天生存率无显著差异。
本研究发现，在接受手术修复的 AMI-VSR 患者中，低剂量输注左西孟旦与术后结局无显著相关性。
