title: Validation of a decision-making strategy for systolic anterior motion following mitral valve repair.
abstract: 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.
authors.affiliation: Anesthesia and Intensive Care Department, Università Vita-Salute San Raffaele, Milan, Italy. landoni.giovanni@hsr.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Crescenzi
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
authors.forename: Davide
authors.initials: D
authors.lastname: Nicolotti
authors.forename: Elena
authors.initials: E
authors.lastname: Bignami
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Iaci
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
authors.forename: Fabio
authors.initials: F
authors.lastname: Guarracino
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass; D017548:Echocardiography, Transesophageal; D005260:Female; D006321:Heart / Q000502:physiology*; D006324:Heart Arrest, Induced; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D008943:Mitral Valve / Q000503:physiopathology* / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000601:surgery; D016343:Monitoring, Intraoperative; D019990:Perioperative Care; D010952:Plasma Substitutes / Q000627:therapeutic use; D011412:Propanolamines / Q000627:therapeutic use; D012086:Reoperation / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D056346:Sternotomy; D013599:Systole / Q000502:physiology
chemical_list: D000319:Adrenergic beta-Antagonists; D010952:Plasma Substitutes; D011412:Propanolamines; C036604:esmolol