LANdiolol to Avoid TAchycardia in Patients at Risk for Cardiovascular Events Undergoing Major Non-cardiac Surgery: a Feasibility Trial
Limiting perioperative tachycardia (aiming for a heart rate \<90 beats per minute throughout the perioperative period) using the ultra-short acting beta-blocker landiolol in patients with cardiovascular risk factors undergoing major surgery might lower the incidence of perioperative myocardial injury. Feasibility of the intervention needs to be proven prior to conduction of a larger trial.
• Patients undergoing elective non-cardiac surgery defined as intermediate or high-risk by the 2022 european society of cardiology (ESC) guidelines
• surgery performed under general anesthesia;
• expected length of hospital stay ≥ 24 hours;
• age ≥ 45 years;
• at least two of the following risk factors:
‣ age ≥ 75 years
⁃ arterial hypertension;
⁃ ischemic heart disease (history of myocardial infarction or positive exercise test, current complaint of chest pain considered to be secondary to myocardial ischemia, use of nitrates, pathological Q waves, prior coronary revascularization);
⁃ history of congestive heart failure;
⁃ history of cerebrovascular disease;
⁃ peripheral artery disease;
⁃ diabetes mellitus;
⁃ GFR ≤ 59 ml/min pro 1.73 m2;
⁃ pre-operative NTproBNP \> 200 pg/ml;
• excessive sympathetic outflow as proven by exercise testing:
‣ impaired heart rate recovery (≤ 12 bpm within 1 minute after cessation of exercise); OR
⁃ exaggerated heart rate response (≥ 12 bpm after 3 minutes of unloaded pedalling);