[Levosimendan and low cardiac output syndrome. Does mortality really decrease? ].

In 1977, Goldman stated that elective surgery should not be performed in patients with signs of heart failure.1 Things have changed considerably in the more than 30 years since the publication of his well-known index. Today, heart failure is no longer necessarily considered a contra-indication to surgical intervention, although it should be carefully evaluated as a risk factor for complications.2 In Spain, over 4 million non-cardiac surgical procedures are performed annually. The relative risk of perioperative complications in these procedures ranges from 0.4% to 11%, depending on the type of surgery and the patient’s prior clinical status. The latter can be assessed in terms of 5 basic parameters involving the presence of ischemic heart disease, congestive heart failure, cerebrovascular disease, renal dysfunction, and insulin-dependent diabetes.2 In comparison to the 4 million patients who receive non-cardiac surgery annually and who have a relatively low risk of cardiovascular morbid-mortality, a total of approximately 15 000 cardiac surgery interventions using extracorporeal circulation (ECC)3 are performed each year in adults. In this type of surgery, prior cardiovascular status is extremely important for prognosis and the, considerably higher, perioperative mortality is the most important individual factor taken into account when evaluating the quality of surgical programs. In 2006, mortality in cardiac surgery which used ECC was 6.7% in Spain.3 There were, nevertheless, considerable differences between different patient groups and, although causes of death were numerous, low cardiac output syndrome (LCOS) was present in many cases. Levosimendan and Low Cardiac Output Syndrome. Does Mortality Really Decrease?