Giovanni Landoni1, Giuseppe Crescenzi1, Alberto Zangrillo1, Davide Nicolotti1, Elena Bignami1, Giuseppe Iaci1, Ottavio Alfieri1, Fabio Guarracino2
1 Anesthesia and Intensive Care Department, Universitą Vita-Salute San Raffaele, Milan, Italy
2 Cardiothoracic Anesthesia, Azienda Ospedaliera Universitaria Pisana, Cisanello Hospital, Pisa, Italy
Low cardiac output syndrome and hypotension are dreadful consequences of systolic anterior motion (SAM) after a mitral valve (MV) repair. The management of SAM in the operating room remains controversial. We validate a recently suggested two-step management method and classification of this complication. This was a teaching hospital-based observational study. We validated a novel two-step conservative management method, consisting in intravascular volume expansion and discontinuation of inotropic drugs (step 1), and increasing the afterload by ascending aorta manual compression while administering esmolol e.v. (step 2). We also validate a novel classification of SAM: easy-to-revert (responding to step 1), difficult-to-revert (responding to step 2), or persistent. Fifty patients had an easy-to-revert while 26 had a difficult-to-revert SAM; 4 patients had a persistent condition (promptly diagnosed through our decisional algorithm) and underwent an immediate second pump run to repeat the mitral repair surgery. We confirmed that SAM after a repair of a degenerative MV is common and validated a simple two-step conservative management method that allows to clearly identify those few patients who require immediate surgical revision.
Cardiothoracic Anesthesia and Intensive Care, Istituto Scientifico San Raffaele, Via Olgettina 60, Milano 20132
Source of Support: None, Conflict of Interest: None
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