Efficacy and safety of perioperative infusion of levosimendan in patients with compromised cardiac function undergoing open-heart surgery: importance of early use

Tasouli, Androniki; Papadopoulos, K.; Antoniou, Theofani; Kriaras, Ioannis; Stavridis, George; Degiannis, Dimitrios; Geroulanos, S

doi:10.1016/j.ejcts.2007.07.010

Cited by 60 publications

(44 citation statements)

References 21 publications

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“…It must be highlighted, however, that ''severe LCOS'' occurred rarely in both groups with no cardiac arrest nor the need for ECMO, suggesting that a larger cohort of patients was needed to achieve a significant result. The major concern with the use of levosimendan regarded its vasodilation properties that could have resulted in excessive hypotension or increased need for vasopressors: for this reason the dose was limited to the lowest described in adults and no boluses were administered [23] while the infusion was prolonged for 72 h. Our data showed that the dual inodilator strategy (levosimendan added to milrinone) did not cause a MAP reduction or an IS increase in the study group. Instead, early lactate levels, IS, and HR were reduced in levosimendan patients.…”

Section: Discussionmentioning

confidence: 71%

Levosimendan infusion in newborns after corrective surgery for congenital heart disease: randomized controlled trial

et al. 2012

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Section: Discussionmentioning

confidence: 71%

Levosimendan infusion in newborns after corrective surgery for congenital heart disease: randomized controlled trial

et al. 2012

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“…Our study demonstrates that prophylactic levosimendan provides positive inotropy and vasodilatation and better tissue perfusion with neutral effect on O2 consumption as manifested by significantly higher SVO2 and SCVO2 in post CPB(SVO2-78.22±4. [24] . Momeni et al found in their study that myocardial oxygen demand is significantly less in levosimendan gr.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Prophylactic Use of Levosimendan andMilrinone in Open Heart Surgery With CompromisedVentricular Function–A Comparative Study

Jana¹,

Nayak²,

Biswal³

2016

AIMDR

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Background: Compromised ventricular function complicates the postoperative course after open heart surgery. Incidence of low-output syndrome (LOS) after cardiopulmonary bypass(CPB) is 30%. Vaso active therapy is required for weaning from bypass. Levosimendan is one of the new class of inodilator useful in refractory cardiac failure. Objective: The aim of this randomized control trial is to detect whether prophylactic levosimendan infusion is superior to milrinone in preserving better tissue perfusion, in decreasing complications related to low output syndromes and better hemodynamic control and to evaluate the efficacy of intravenous levosimendan infusion in decreasing the use of high dose of conventional inotropes and consequent prolonged hospitalization in open heart surgery patients with preoperative compromised ventricular function. Methods: Thirty consecutive patients with compromised cardiac function belongs to American Society of Anesthesiologists(ASA) physical status III who underwent open-heart surgery with CBP were randomly divided into two groups. Gr-L received levosimendan (loading dose of 12 μg/kg over 10 mins followed by infusion dose of (0.1 μg/kg /min ) and Gr-M received milrinone loading dose of 50 μg/kg over 10 mins followed by infusion dose of (0.5 μg/kg/ min )after anesthesia induction. Hemodynamic profile, mixed or central venous oxygen saturation (SVO2, SCVO2) which are surrogate markers for cardiac output, tissue perfusion were recorded, and blood obtained for troponin level. Results: SVO2 and SCVO2 were significantly higher in Gr L versus Gr M. Postoperative troponin-I concentrations, need of other inotropes incidence of arrhythmia, re-intubation, Intensive care unit(ICU) stay and hospital stay were significantly decreased in Gr L. Conclusion: Prophylactic levosimendan infusion maintains better hemodynamic control, tissue perfusion, myocardial protection and lesser complications in patients with compromised ventricular function.

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“…Levosimendan before CABG showed evidence of less myocardial damage, suggestive of a preconditioning effect Tasouli et al 42 45 Determine the proper time for its infusion during or after open-heart surgery to avoid complications related with lowoutput syndrome and high dosage of inotropes Levosimendan is a safe and effi cient choice in the management of lowoutput syndrome during and after CABG CABG, coronary artery bypass grafting; CPB, cardiopulmonary bypass; IABP, intra-aortic balloon pumping gram. 31 The administration of levosimendan in patients with coronary syndrome results in an effective hemodynamic improvement.…”

Section: Use Of Levosimendan In Patients Undergoing Percutaneous Coromentioning

confidence: 99%

Use of levosimendan in patients with ischemic heart disease following mechanical reperfusion

Kurt

2009

Surg Today

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Cardiac failure is among the most significant conditions associated with acute coronary syndrome. In ischemic heart disease, serious hemodynamic problems are reported in patients with left ventricular dysfunction during the acute phase despite mechanical revascularization. Several positive inotropic agents in addition to intra-aortic balloon pump (IABP) are required to support patients with impaired left ventricular pump function during this phase. Intravenous inotropic agents, beta-mimetics, and phosphodiesterase inhibitors lead to increases in the incidence of arrhythmia and myocardial O(2) consumption owing to their effect of increasing intracellular calcium amount, although they produce rapid hemodynamic improvements in cardiac failure. This causes severe problems particularly in cardiac failure of ischemic origin. Recently, levosimendan, a calcium-sensitizing agent with cardioprotective properties, is being used alone or in combination with IABP in cases with severe left ventricular systolic dysfunction during mechanical revascularization procedures (percutaneous coronary interventions, coronary bypass surgery). This review includes studies with levosimendan in cases not recovering due to myocardial stunning in the acute phase despite mechanical approaches applied.

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Efficacy and safety of perioperative infusion of levosimendan in patients with compromised cardiac function undergoing open-heart surgery: importance of early use

Abstract: Levosimendan is a safe and efficient choice in the management of low-output syndrome during and after open-heart surgery. The shortening of hospitalisation and the trend for better outcome confirm its clear superiority when the infusion starts from the operating theatre.

Cited by 60 publications

References 21 publications

Levosimendan infusion in newborns after corrective surgery for congenital heart disease: randomized controlled trial

Levosimendan infusion in newborns after corrective surgery for congenital heart disease: randomized controlled trial

Outcome of Prophylactic Use of Levosimendan andMilrinone in Open Heart Surgery With CompromisedVentricular Function–A Comparative Study

Use of levosimendan in patients with ischemic heart disease following mechanical reperfusion

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