Management of perioperative heart failure.

PURPOSE OF REVIEW

In the perioperative period, acute heart failure can result from a variety of conditions, and treatment may vary considerably depending on its mechanism. This review aims to provide conceptual framework by selectively presenting recent knowledge and advances in acute heart failure therapies including drugs (inotropes, diuretics) and devices (mechanical assistance, biventricular pacing, ultrafiltration).

RECENT FINDINGS

The calcium sensitizer levosimendan, showed a mortality benefit in cardiac surgery patients in a recent meta-analysis. A study involving patients with cardiogenic shock complicating myocardial infarction for which early revascularization was planned, intra-aortic balloon support did not reduce 30-day mortality. A novel study showed that ultrafiltration was inferior to pharmacologic therapy in acute heart failure in nonsurgical patients. Biventricular pacing provided a significant clinical benefit over right ventricular pacing in nonsurgical patients with left ventricular dysfunction and atrioventricular block. Two recently published meta-analyses confirmed the prognostic role of natriuretic peptides in the perioperative setting.

SUMMARY

Poor data exist in the perioperative setting concerning acute heart failure therapies. Large trials are needed to support the use of levosimendan, mechanical assistance, utrafiltration and biventricular pacing in the perioperative setting. The prognostic role of natriuretic peptides was confirmed in the perioperative period.