Esmolol as a cardioprotective agent to reduce low cardiac output syndrome after cardiac surgery

Early postoperative left ventricular dysfunction due to myocardial stunning can negatively affect outcomes in patients with mitral regurgitation undergoing mitral valve surgery. The aim of this study was to evaluate the impact of the ultra-short acting β-blocking agent esmolol, administered after the anesthesia induction and before aortic cross-clamping, on myocardial protection and on postoperative clinical course in patients undergoing mitral valve surgery for mitral regurgitation. Patients undergoing mitral valve surgery for primary mitral regurgitation were analyzed according to the use or not of esmolol. Clinical, procedural and laboratory data were collected. A 1:2 propensity score matching analysis (esmolol vs. control) was performed to adjust for baseline differences. The primary endpoint was the occurrence of postoperative low cardiac output syndrome. Out of 322 patients (age: 66 ± 11 years; 140 women) with mitral regurgitation undergoing mitral valve surgery, 99 received esmolol while 223 patients did not. Low cardiac output syndrome occurred significantly less frequently in patients treated with esmolol as compared to patients not receiving it (12.1% vs. 33.2%, p < 0.001 before matching and 13.0% vs. 30.4%, p = 0.006 after matching). Peak post-procedural creatin kinase MB release was lower in patients treated with esmolol as compared to those not treated with esmolol (57 ± 30 µg/mL vs. 82 ± 70 µg/mL, p < 0.001 before matching and 57 ± 31 µg/mL vs. 83 ± 79 µg/mL, p = 0.008 after matching). Acute kidney injury and length of intensive care unit stay were reduced in the esmolol group both before and after matching. In conclusion esmolol administered after anesthesia induction and before aortic cross-clamping could improve myocardial protection in patients with mitral regurgitation undergoing mitral valve surgery.