Assessing the effect of preoperative levosimendan on renal function in patients with right ventricular dysfunction

Orriach, José Luis Guerrero; Ortega, M. Galán; Fernández, A; Villanueva, Daniel Ariza; Vela, Agustín; Cortés, Ignacio; Navarro, Manuel Rubio; Mañas, José Cruz

doi:10.1007/s10877-016-9827-7

Cited by 4 publications

(3 citation statements)

References 18 publications

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“…There is cumulative evidence that levosimendan improves renal function in patients who have undergone recent cardiac surgery (Bragadottir et al, 2013;Baysal et al, 2014;Guerrero-Orriach et al, 2016;Guerrero Orriach et al, 2017;CHEETAH Study Group, 2018;Qiang et al, 2018;Wang et al, 2019). Nevertheless, the positive effects of the preoperative administration of levosimendan have been recently questioned (Cholley et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Renal and Neurologic Benefit of Levosimendan vs Dobutamine in Patients With Low Cardiac Output Syndrome After Cardiac Surgery: Clinical Trial FIM-BGC-2014-01

et al. 2020

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Section: Discussionmentioning

confidence: 99%

Renal and Neurologic Benefit of Levosimendan vs Dobutamine in Patients With Low Cardiac Output Syndrome After Cardiac Surgery: Clinical Trial FIM-BGC-2014-01

et al. 2020

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“…Whether patients with preoperative treatment with beta-blockers may benefit more from levosimendan remains speculative and should be explored in subgroup analyses. Furthermore, levosimendan could offer advantages in patients with right ventricular systolic and diastolic dysfunction, with or without associated pulmonary hypertension [ 43 – 45 ].…”

Section: Discussionmentioning

confidence: 99%

Levosimendan for patients with severely reduced left ventricular systolic function and/or low cardiac output syndrome undergoing cardiac surgery: a systematic review and meta-analysis

et al. 2017

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BackgroundPrevious studies have shown beneficial effects of levosimendan in high-risk patients undergoing cardiac surgery. Two large randomized controlled trials (RCTs), however, showed no advantages of levosimendan.MethodsWe performed a systematic review and meta-analysis (MEDLINE and Embase from inception until March 30, 2017), investigating whether levosimendan offers advantages compared with placebo in high-risk cardiac surgery patients, as defined by preoperative left ventricular ejection fraction (LVEF) ≤ 35% and/or low cardiac output syndrome (LCOS). The primary outcomes were mortality at longest follow-up and need for postoperative renal replacement therapy (RRT). Secondary postoperative outcomes investigated included myocardial injury, supraventricular arrhythmias, development of LCOS, acute kidney injury (AKI), duration of mechanical ventilation, intensive care unit and hospital lengths of stay, and incidence of hypotension during drug infusion.ResultsSix RCTs were included in the meta-analysis, five of which investigated only patients with LVEF ≤ 35% and one of which included predominantly patients with LCOS. Mortality was similar overall (OR 0.64 [0.37, 1.11], p = 0.11) but lower in the subgroup with LVEF < 35% (OR 0.51 [0.32, 0.82], p = 0.005). Need for RRT was reduced by levosimendan both overall (OR 0.63 [0.42, 0.94], p = 0.02) and in patients with LVEF < 35% (OR 0.55 [0.31, 0.97], p = 0.04). Among secondary outcomes, we found lower postoperative LCOS in patients with LVEF < 35% receiving levosimendan (OR 0.49 [0.27, 0.89], p = 0.02), lower overall AKI (OR 0.62 [0.42, 0.92], p = 0.02), and a trend toward lower mechanical support, both overall (p = 0.07) and in patients with LVEF < 35% (p = 0.05).ConclusionsLevosimendan reduces mortality in patients with preoperative severely reduced LVEF but does not affect overall mortality. Levosimendan reduces the need for RRT after high-risk cardiac surgery.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1849-0) contains supplementary material, which is available to authorized users.

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“…We could just hypothesize that the pre- and poste-valuation within patients previously identified as high risk of postoperative organ dysfunction is sufficient to assess the properties of the drug at multiorgan level, as has been done by other authors, but we need to confirm it by other randomized studies. 5 , 8 , 32 , 40 , 41 Larger studies in cardiac surgery are warranted to clarify the renal and neuronal effects of levosimendan and adverse effects. 42 …”

Section: Discussionmentioning

confidence: 99%

Cardiac, renal, and neurological benefits of preoperative levosimendan administration in patients with right ventricular dysfunction and pulmonary hypertension undergoing cardiac surgery: evaluation with two biomarkers neutrophil gelatinase-associated lipocalin and neuronal enolase

Guerrero-Orriach¹,

Ariza-Villanueva²,

Florez-Vela³

et al. 2016

TCRM

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PurposeTo evaluate if the preoperative administration of levosimendan in patients with right ventricular (RV) dysfunction, pulmonary hypertension, and high perioperative risk would improve cardiac function and would also have a protective effect on renal and neurological functions, assessed using two biomarkers neutrophil gelatinase-associated lipocalin (N-GAL) and neuronal enolase.MethodsThis is an observational study. Twenty-seven high-risk cardiac patients with RV dysfunction and pulmonary hypertension, scheduled for cardiac valve surgery, were prospectively followed after preoperative administration of levosimendan. Levosimendan was administered preoperatively on the day before surgery. All patients were considered high risk of cardiac and perioperative renal complications. Cardiac function was assessed by echocardiography, renal function by urinary N-GAL levels, and the acute kidney injury scale. Neuronal damage was assessed by neuron-specific enolase levels.ResultsAfter surgery, no significant variations were found in mean and SE levels of N-GAL (14.31 [28.34] ng/mL vs 13.41 [38.24] ng/mL), neuron-specific enolase (5.40 [0.41] ng/mL vs 4.32 [0.61] ng/mL), or mean ± SD creatinine (1.06±0.24 mg/dL vs 1.25±0.37 mg/dL at 48 hours). RV dilatation decreased from 4.23±0.7 mm to 3.45±0.6 mm and pulmonary artery pressure from 58±18 mmHg to 42±19 mmHg at 48 hours.ConclusionPreoperative administration of levosimendan has shown a protective role against cardiac, renal, and neurological damage in patients with a high risk of multiple organ dysfunctions undergoing cardiac surgery.

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Assessing the effect of preoperative levosimendan on renal function in patients with right ventricular dysfunction

Cited by 4 publications

References 18 publications

Renal and Neurologic Benefit of Levosimendan vs Dobutamine in Patients With Low Cardiac Output Syndrome After Cardiac Surgery: Clinical Trial FIM-BGC-2014-01

Renal and Neurologic Benefit of Levosimendan vs Dobutamine in Patients With Low Cardiac Output Syndrome After Cardiac Surgery: Clinical Trial FIM-BGC-2014-01

Levosimendan for patients with severely reduced left ventricular systolic function and/or low cardiac output syndrome undergoing cardiac surgery: a systematic review and meta-analysis

Cardiac, renal, and neurological benefits of preoperative levosimendan administration in patients with right ventricular dysfunction and pulmonary hypertension undergoing cardiac surgery: evaluation with two biomarkers neutrophil gelatinase-associated lipocalin and neuronal enolase

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