Effectiveness of prophylactic levosimendan in high-risk valve surgery patients : cardiovascular topics

Abstract

BackgroundLevosimendan has anti-ischaemic effects, improves myocardial contractility and increases systemic, pulmonary and coronary vasodilatation. These properties suggest potential advantages in high-risk cardiac valve surgery patients where cardioprotection would be valuable. The present study investigated the peri-operative haemodynamic effects of prophylactic levosimendan infusion in cardiac valve surgery patients with low ejection fraction and/or severe pulmonary arterial hypertension.MethodsBetween May 2006 and July 2007, 20 consecutive patients with severe pulmonary arterial hypertension (systolic pulmonary artery pressure ≥ 60 mmHg) and/or low ejection fraction (< 50%) who underwent valve surgery in our clinic were included in the study and randomised into two groups. Levosimendan was administered to 10 patients in group I and not to the 10 patients in the control group. Cardiac output (CO), cardiac index (CI), systemic vascular resistance (SVR), pulmonary vascular resistance (PVR) and mean pulmonary artery pressure (MPAP) were recorded for each patient preoperatively and for 24 hours following the operation.ResultsCO and CI values were higher in the levosimendan group during the study period (p < 0.05). MPAP and PVR values were significantly lower in the levosimendan group for the 24-hour period (p < 0.05) and SVR values were significantly lower after 24 hours in both groups. When clinical results were considered, no difference in favour of levosimendan was detected regarding the mortality and morbidity rates between the groups.ConclusionLevosimendan improved the haemodynamics in cardiac valve surgery patients with low ejection fraction and/or severe pulmonary arterial hypertension, and facilitated weaning from cardiopulmonary bypass in such high-risk patients when started as a prophylactic agent.

Influence of Levosimendan Postconditioning on Apoptosis of Rat Lung Cells in a Model of Ischemia–Reperfusion Injury

“…Levosimendan is used widely to treat heart failure [ 19 , 20 ]. A possible mechanism of action is enhancement of myocardial contraction by increasing the sensitivity between Ca 2+ and myofilaments, leading to depletion of [Ca 2+ ] i .…”

Cost-benefits of incorporating levosimendan into cardiac surgery practice: German base case

“…The clinical benefits of using levosimendan in cardiac surgery have been demonstrated in a number of studies [1,17,[36][37][38][39][40]. In the current economic analysis, which evaluated the costs of levosimendan compared with dobutamine in patients requiring inotropic support following cardiac surgery in Germany, levosimendan was found to be cost saving from the hospital and health insurance perspectives.…”

Usage and Results of Levosimendan in Ischemic Mitral Valve Surgery

“…It also increases the myocardial contractility and cardiac output without increasing the oxygen demand of myocardia (6). Short-term infusion of levosimendan allows lower level of damage on dysfunctional myocardia and creates the preconditioning effect (7,8). Besides, it has effects on improving the cardiac index and mean arterial pressure and decreasing the pulmonary capillary wedge pressure (6)(7)(8)(9).…”