Comparative Effect of Levosimendan and Milrinone in Cardiac Surgery Patients With Pulmonary Hypertension and Left Ventricular Dysfunction

Mishra, Abhi; Kumar, Bhupesh; Dutta, Vikas; Arya, Virendra K.; Mishra, Anand

doi:10.1053/j.jvca.2016.01.015

Cited by 43 publications

(26 citation statements)

References 35 publications

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“…In a randomized clinical trial in patients with PH undergoing valve replacement, levosimendan was found as effective as milrinone in improving biventricular function and reducing mean pulmonary arterial pressure and pulmonary vascular resistance. 42 However, levosimendan resulted in a greater increase in heart rate, decrease in systemic vascular resistance, and a greater need for norepinephrine.…”

Section: Levosimendan In Phmentioning

confidence: 99%

Levosimendan in pulmonary hypertension and right heart failure

Hansen¹,

Andersen²,

Nielsen‐Kudsk³

2018

Pulm. circ.

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Pulmonary hypertension is a multifactorial disease with a high morbidity and mortality. Right ventricular function is the most important predictor of morbidity and mortality in patients suffering from pulmonary hypertension, but currently there are no approved treatments directly supporting the failing right ventricle. Levosimendan is a calcium sensitizing agent with inotropic, pulmonary vasodilatory, and cardioprotective properties. Given its pharmacodynamic profile, levosimendan could be a potential novel agent for the treatment of right ventricular failure caused by pulmonary hypertension. The aim of this review is to provide an overview of the current knowledge on the effects of levosimendan in pulmonary hypertension and right heart failure.

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Section: Levosimendan In Phmentioning

confidence: 99%

Levosimendan in pulmonary hypertension and right heart failure

Hansen¹,

Andersen²,

Nielsen‐Kudsk³

2018

Pulm. circ.

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“…Levosimendan, a calcium sensitizer, has been shown to improve RV function in left heart disease [ 85 ]. However, in a study comparing levosimendan with milrinone in patients undergoing cardiac surgery, levosimendan resulted in a greater increase in heart rate, a decrease in systemic vascular resistance, and a greater need for norepinephrine [ 86 ].…”

Section: The Treatment Of Rvfmentioning

confidence: 99%

The Dark Side of the Moon: The Right Ventricle

Foschi

Mauro

Tancredi

et al. 2017

JCDD

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The aim of this review article is to summarize current knowledge of the pathophysiology underlying right ventricular failure (RVF), focusing, in particular, on right ventricular assessment and prognosis. The right ventricle (RV) can tolerate volume overload well, but is not able to sustain pressure overload. Right ventricular hypertrophy (RVH), as a response to increased afterload, can be adaptive or maladaptive. The easiest and most common way to assess the RV is by two-dimensional (2D) trans-thoracic echocardiography measuring surrogate indexes, such as tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and tissue Doppler velocity of the lateral aspect of the tricuspid valvular plane. However, both volumes and function are better estimated by 3D echocardiography and cardiac magnetic resonance (CMR). The prognostic role of the RV in heart failure (HF), pulmonary hypertension (PH), acute myocardial infarction (AMI), and cardiac surgery has been overlooked for many years. However, several recent studies have placed much greater importance on the RV in prognostic assessments. In conclusion, RV dimensions and function should be routinely assessed in cardiovascular disease, as RVF has a significant impact on disease prognosis. In the presence of RVF, different therapeutic approaches, either pharmacological or surgical, may be beneficial.

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“…In a recent study, Mishra et al . [ 9 ] compared the effects of intravenous levosimendan and intravenous milrinone in cardiac surgery patients with PH and left ventricular dysfunction. The major side effect of using intravenous levosimendan was a fall in SVR, leading to systemic hypotension.…”

Section: Discussionmentioning

confidence: 99%

“…However, intravenous administration is limited by systemic hypotension because of nonselective vasodilation and by hypoxemia through worsening of intrapulmonary shunt caused by inhibition of hypoxic pulmonary vasoconstriction. [ 7 8 9 ]…”

Section: Introductionmentioning

confidence: 99%

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Inhaled levosimendan versus intravenous levosimendan in patients with pulmonary hypertension undergoing mitral valve replacement

Kundra¹,

Nagaraja²,

Bharathi³

et al. 2018

Ann Card Anaesth

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Context:Inhaled levosimendan may act as selective pulmonary vasodilator and avoid systemic side effects of intravenous levosimendan, which include decrease in systemic vascular resistance (SVR) and systemic hypotension, but with same beneficial effect on pulmonary artery pressure (PAP) and right ventricular (RV) function.Aim:The aim of this study was to compare the effect of inhaled levosimendan with intravenous levosimendan in patients with pulmonary hypertension undergoing mitral valve replacement.Settings and Design:The present prospective randomized comparative study was conducted in a tertiary care hospital.Subjects and Methods:Fifty patients were randomized into two groups (n = 25). Group A: Levosimendan infusion was started immediately after coming-off of cardiopulmonary bypass and continued for 24 h at 0.1 mcg/kg/min. Group B: Total dose of levosimendan which would be given through intravenous route over 24 h was calculated and then divided into four equal parts and administered through inhalational route 6th hourly over 24 h. Hemodynamic profile (pulse rate, mean arterial pressure, pulmonary artery systolic pressure [PASP], SVR) and RV function were assessed immediately after shifting, at 1, 8, 24, and 36 h after shifting to recovery.Statistical Analysis Used:Intragroup analysis was done using paired student t-test, and unpaired student t-test was used for analysis between two groups.Results:PASP and RV-fractional area change (RV-FAC) were comparable in the two groups at different time intervals. There was a significant reduction in PASP and significant improvement in RV-FAC with both intravenous and inhalational levosimendan. SVR was significantly decreased with intravenous levosimendan, but no significant decrease in SVR was observed with inhalational levosimendan.Conclusions:Inhaled levosimendan is a selective pulmonary vasodilator. It causes decrease in PAP and improvement in RV function, without having a significant effect on SVR.

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Comparative Effect of Levosimendan and Milrinone in Cardiac Surgery Patients With Pulmonary Hypertension and Left Ventricular Dysfunction

Cited by 43 publications

References 35 publications

Levosimendan in pulmonary hypertension and right heart failure

Levosimendan in pulmonary hypertension and right heart failure

The Dark Side of the Moon: The Right Ventricle

Inhaled levosimendan versus intravenous levosimendan in patients with pulmonary hypertension undergoing mitral valve replacement

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