Introduction: Veno-arterial extracorporeal membrane oxygenation may be used to support patients with refractory cardiogenic shock. Many patients can be successfully weaned, the ability of some medications to facilitate weaning from veno-arterial extracorporeal membrane oxygenation were reported. To date, there are limited studies investigating the impact of levosimendan on veno-arterial extracorporeal membrane oxygenation weaning. The objective of this systematic review and meta-analysis was to assess the effects of levosimendan on successful weaning from veno-arterial extracorporeal membrane oxygenation and survival in adult patients with cardiogenic shock. Methods: We performed a systematic review and meta-analysis (PubMed, the Cochrane Library, and the International Clinical Trials Registry Platform published from the year 2000 onwards) investigating whether levosimendan offers advantages compared to standard therapy or placebo, in cardiogenic shock adult patients treated with veno-arterial extracorporeal membrane oxygenation. The primary outcome was veno-arterial extracorporeal membrane oxygenation successful weaning, whereas secondary outcome was all-cause mortality at the longest follow-up available. We pooled risk ratio and 95% confidence interval using fixed and random effects models according to the heterogeneity. Results: A total of five non-randomized clinical trials comprising 557 patients were included, 299 patients for levosimendan and 258 patients for control groups. The pooled prevalence of veno-arterial extracorporeal membrane oxygenation successful weaning was 61.4% (95% confidence interval 39.8-82.9%), and all-cause mortality was 36% (95% confidence interval 29.6-48.8%). There was a significant increase in veno-arterial extracorporeal membrane oxygenation successful weaning with levosimendan compared to the controls (risk ratio = 1.42 (95% confidence interval 1.12-1.8), p for effect = 0.004, I2 = 71%). A decrease risk of all-cause mortality in the levosimendan group was also observed, risk ratio = 0.62 (95% confidence interval 0.44-0.88), p for effect = 0.007, I2 = 36%. Conclusion: The use of levosimendan on adult patients with cardiogenic shock may facilitate the veno-arterial extracorporeal membrane oxygenation weaning and reduce all-cause mortality. Few articles of this topic are available, and prospective, randomized multi-center trials are warranted to conclude decisively on the benefits of levosimendan in this setting.

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Introduction Atrial fibrillation after cardiac surgery (AFCS) is associated with an increase in adverse events. The scores POAF, CHA2DS2-VASc and HATCH demonstrated a validated predictive to predict AF after CS (AFCS). Purpose To develop and validate a new risk score from the combination of the variables with highest predictive value of POAF, CHA2DS2-VASc and HATCH risk scores to predict AFCS. Methodology We conducted a single-center cohort study, performing a retrospective analysis of prospectively collected data. The study included consecutive patients undergoing CS between 2010–2016. The primary outcome was the development of new-onset AFCS during hospitalization. The variables of each score were evaluated in a multivariate regression model to determine the predictive impact. Discrimination was evaluated with area under the ROC curve (AUC-ROC) and calibration using the Hosmer-Lemeshow (HL) test. The Youden index was used to establish the best cut-off point for the score. The statistical difference between the ROC curves was evaluated with the method of DeLong et al. Results 3113 patients were included. Coronary artery bypass graft surgery 45%, valve replacement 24%, combined procedure (revascularization-valve surgery) 15%, and other procedures 16%. 21% (n=654) presented AFCS. Variables finally included in the new score were: age (≥75: 2, 65–74: 1), heart failure (2), female sex (1), hypertension (1), diabetes (1), previous stroke (1). The new score presented an AUC of 0.78 (95% CI 0.78–0.80), the rest of the scores presented lower discrimination ability (P<0.001): CHAD2DS2-VASc AUC 0.76, POAF 0.71 and HATCH 0.70. The HL test showed a p>0.05. For the new score, the best cut-off point was 2, with a sensitivity of 82% and specificity of 65.9%, presenting high negative predictive value: 92.9%. Variables OR (CI 95%) P Age (years)   65–74 3.14 (2.29–4.31) <0.001   ≥75 8.68 (6.32–11.93) <0.001 Female sex 3.36 (2.68–4.22) <0.001 Heart failure 2.45 (1.82–3.31) <0.001 Stroke/TIA 2.33 (1.45–3.76) <0.001 Hypertension 1.68 (1.28–2.2) <0.001 Diabetes 1.72 (1.31–2.25) <0.001 Conclusion From the combination of variables with higher predictive value included in the POAF, CHA2DS2-VASc, and HATCH scores, a new risk system was created to predict AFCS, presenting a greater predictive ability than the original ones. Being necessary future prospective validations.

Background and Aims: Atrial fibrillation frequently occurs in the postoperative period of cardiac surgery, associated with an increase in morbidity and mortality. The scores POAF, CHA2DS2-VASc and HATCH demonstrated a validated ability to predict atrial fibrillation after cardiac surgery (AFCS). The objective is to develop and validate a risk score to predict AFCS from the combination of the variables with highest predictive value of POAF, CHA2DS2-VASc and HATCH models. Methods: We conducted a single-center cohort study, performing a retrospective analysis of prospectively collected data. The study included consecutive patients undergoing cardiac surgery in 2010-2016. The primary outcome was the development of new-onset AFCS. The variables of the POAF, CHA2DS2-VASc and HATCH scores were evaluated in a multivariate regression model to determine the predictive impact. Those variables that were independently associated with AFCS were included in the final model. Results: A total of 3113 patients underwent cardiac surgery, of which 21% presented AFCS. The variables included in the new score COM-AF were: age (≥75: 2 points, 65-74: 1 point), heart failure (2 points), female sex (1 point), hypertension (1 point), diabetes (1 point), previous stroke (2 points). For the prediction of AFCS, COM-AF presented an AUC of 0.78 (95% CI 0.76-0.80), the rest of the scores presented lower discrimination ability (P < 0.001): CHA2DS2-VASc AUC 0.76 (95% CI 0.74-0.78), POAF 0.71 (95% CI 0.69-0.73) and HATCH 0.70 (95% CI: 0, 67-0.72). Multivariable analysis demonstrated that COM-AF score was an independent predictor of AFCS: OR 1,91 (IC 95% 1,63-2,23). Conclusion: From the combination of variables with higher predictive value included in the POAF, CHA2DS2-VASc, and HATCH scores, a new risk model system called COM-AF was created to predict AFCS, presenting a greater predictive ability than the original ones. Being necessary future prospective validations.