Landiolol in Mitral Valve Surgery

Inclusion Criteria: * Older than 18 years; * Elective mitral valve repair or replacement surgery with planned cardiopulmonary bypass via midline sternotomy or minithoracotomy; * Preoperative evidence of left ventricular end-systolic diameter \>40 mm and/or left ventricular end-diastolic diameter \>60 mm and/or left ventricular ejection fraction\<60%; * Signed informed consent. Exclusion Criteria: * Need for preoperative dialysis; * Hepatic dysfunction (defined as Child-Pugh class C); * History of previous unusual response to beta-blockers; * Urgent or emergency surgery; * Patient already in need of mechanical circulatory support before surgery (except for IABP); * Pregnancy as documented by a pregnancy test performed in the last 72h before surgery; * Patients with preoperative evidence of hypernatremia (serum sodium concentration: \> 160 mmol/L); * Patients with preoperative evidence of hyperchloremia (serum chloride concentration: \>115 mmol/L); * Patients with hypersensitivity to the active substance or to any of the excipients; * Patients with severe bradycardia (less than 50 beats per minute) sick sinus syndrome, severe atrioventricular nodal conductance disorders or 2nd -3rd degree atrioventricular block and without a pacemaker; * Patients with cardiogenic shock, severe hypotension (MAP\<50 mmHg), decompensated heart failure or severe pulmonary hypertension (PAPs \>70 mmHg); * Patients with non-treated phaeochromocytoma; * Patients with acute asthmatic attack; * Patients with severe, uncorrectable metabolic acidosis. * Participation in a clinical trial in which an investigational drug was administered within 30 days of screening or within the 5 half-lives of the study drug, whichever is longer. * Planned use of ultra-short acting beta-blockers as intraoperative cardiac protective strategy. * Refusal or inability to sign the informed consent.