Landiolol Use to Control Heart Rate in Patients Aged 45 and Older at Risk of Heart Problems Undergoing Major Non-Cardiac Surgery A Feasibility Study

What this Trial Is About

Researchers are studying the use of the ultra-short acting beta-blocker landiolol to limit perioperative tachycardia in patients aged 45 and older who have cardiovascular risk factors and are undergoing major non-cardiac surgery. The study aims to see if controlling heart rate below 90 beats per minute during the perioperative period can reduce the risk of myocardial injury, a serious complication associated with increased mortality after surgery. This feasibility trial will help determine if this intervention can be safely and effectively applied before a larger trial is conducted. Participants will be randomly assigned to one of two groups. In the experimental group, landiolol will be given during surgery, with the dose adjusted between 1 to 40 mcgkgmin to maintain a heart rate below 90 beats per minute, while ensuring mean arterial pressure stays above 65 mmHg. The control group will receive usual care, focusing on maintaining mean arterial pressure above 65 mmHg and addressing any causes of tachycardia such as low blood volume or pain. The intervention period spans from the induction of anesthesia until discharge from the postanesthetic care unit. During the study, participants will be closely monitored for heart rate, blood pressure, and use of vasopressors. Researchers will measure the percentage of time the heart rate remains within the target range, as well as secondary outcomes like length of stay in the postanesthetic care unit and hospital, total vasopressor dose, and incidence of perioperative myocardial injury within 72 hours after surgery. The study starts in April 2026 and will continue through March 2028, with safety and feasibility as key focuses throughout the trial.

LANdiolol to Avoid TAchycardia in Patients at Risk for Cardiovascular Events Undergoing Major Non-cardiac Surgery