Short summary

The right ventricle is not well described in the literature, and is not an independent factor in prognosticating the risk of cardiac valve surgery when using the EURO I and II -scores.

Main focus is on the left ventricle and pulmonary artery pressures when preparing a patient for valve surgery. But what if pulmonary artery pressure is low because of a failing right ventricle? Can we find any connection between failing RV function and the need for severe inotropic support.

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Rationale

The right ventricle is not well described in the literature, and is not an independent factor in prognosticating the risk of cardiac valve surgery when using the EURO I and II -scores.

Main focus is on the left ventricle and pulmonary artery pressures when preparing a patient for valve surgery. But what if pulmonary artery pressure is low because of a failing right ventricle? Can we find any connection between failing RV function and the need for severe inotropic support with levosimendan?

We will identify all patients treated with levosimendan either in the OR or in the ICU while having a mitral/aortic repair/replacement during a two year period between 2014 and 2015, by searching the Vestdansk Hjertedatabase. Levosimendan in this setting is a marker of severe postoperative cardiogenic shock, and is administered either alone or in conjunction with mechanical circulatory support.

The study population will be investigated by evaluation of the pre- and perioperative TEE with regards to signs of RV failure, RV hypertrophy or RV dilatation. Together with data from the medical journal and hemodynamic data it will be established whether a connection can be made between RV failure and the need for levosimendan.

A control group of patients undergoing the same procedures and with the same preoperative risk judged by the euroscore and patient characteristics is needed in order see if there is an overrepresentation of RV failure or not the group treated with levosimendan. This group will be found by propensity score matching (if possible).

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Description of the cohort

The cohort is based on adult patients who have undergone open cardiac valve surgery in the aortic or mitral position in Odense Universitets Hospital during the years 2014 and 2015. 

Data and biological material

Clinical data from Vestdansk Hjertedatabase, Philips Excelera, Patient journals.

Collaborating researchers and departments

Department of Anesthesiology, Odense University Hospital

• Medical specialist Kasper Enovold Nielsen
• Consultant Claus Andersen

Department of Cardiology, Odense University Hospital

• Professor Jacob Eifer Møller