Sugimura Yukiharu, Kalampokas Nikolaos, Arikan Metin, Rellecke Phillip, Dalyanoglu Hannan, Tudorache Igor, Westenfeld Ralf, Boeken Udo, Lichtenberg Artur, Akhyari Payam, Aubin Hug
Department of Cardiac Surgery, Medical Faculty and University Hospital, Heinrich-Heine-University Medical School, Duesseldorf, Germany.
Department of Cardiac Surgery, Medical Faculty and RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany.
Interdiscip Cardiovasc Thorac Surg. 2023 Jan 9;36(1). doi: 10.1093/icvts/ivac289.
Perioperative mortality and complications still remain high after left ventricular assist device (LVAD) implantation, especially in highly compromised patient cohorts. Here, we evaluate the effects of preoperative Levosimendan therapy on peri- and postoperative outcomes after LVAD implantation.
We retrospectively analysed 224 consecutive patients with LVAD implantation for end-stage heart failure between November 2010 and December 2019 in our centre with regard to short- and longer-term mortality as well as incidence of postoperative right ventricular failure (RV-F). Out of these, 117 (52.2%) received preoperative i.v. Levosimendan therapy within 7 days before LVAD implantation (Levo group).
In-hospital, 30-day and 5-year mortality was comparable (in-hospital mortality: 18.8% vs 23.4%, P = 0.40; 30-day mortality: 12.0% vs 14.0%, P = 0.65; Levo vs control group). However, in the multivariate analysis, preoperative Levosimendan therapy significantly reduced postoperative RV-F but increased postoperative vasoactive inotropic score ([RV-F: odds ratio 2.153, confidence interval 1.146-4.047, P = 0.017; vasoactive inotropic score 24 h post-surgery: odds ratio 1.023, confidence interval 1.008-1.038, P = 0.002). These results were further confirmed by 1:1 propensity score matching of 74 patients in each group. Especially in the subgroup of patients with normal preoperative RV function, the prevalence of postoperative RV-F was significantly lower in the Levo- group as compared to the control group (17.6% vs 31.1%, P = 0.03; respectively).
Preoperative Levosimendan therapy reduces the risk of postoperative RV-F, especially in patients with normal preoperative RV function without effects on mortality up to 5 years after LVAD implantation.
左心室辅助装置（LVAD）植入术后围手术期死亡率和并发症仍然很高，尤其是在病情严重的患者群体中。在此，我们评估术前左西孟旦治疗对LVAD植入术后围手术期和术后结局的影响。
我们回顾性分析了2010年11月至2019年12月期间在我们中心连续接受LVAD植入治疗终末期心力衰竭的224例患者的短期和长期死亡率以及术后右心室衰竭（RV-F）的发生率。其中，117例（52.2%）在LVAD植入前7天内接受了术前静脉注射左西孟旦治疗（左西孟旦组）。
住院、30天和5年死亡率相当（住院死亡率：18.8%对23.4%，P = 0.40；30天死亡率：12.0%对14.0%，P = 0.65；左西孟旦组对对照组）。然而，在多变量分析中，术前左西孟旦治疗显著降低了术后RV-F，但增加了术后血管活性药物评分（[RV-F：比值比2.153，置信区间1.146 - 4.047，P = 0.017；术后24小时血管活性药物评分：比值比1.023，置信区间1.008 - 1.038，P = 0.002]）。每组74例患者的1:1倾向评分匹配进一步证实了这些结果。特别是在术前RV功能正常的患者亚组中，左西孟旦组术后RV-F的发生率显著低于对照组（分别为17.6%对31.1%，P = 0.03）。
术前左西孟旦治疗可降低术后RV-F的风险，尤其是在术前RV功能正常的患者中，且对LVAD植入术后5年内的死亡率无影响。
