Levosimendan and severe pulmonary hypertension during open heart surgery

Çiçekçioğlu, Ferit; Parlar, Ali İhsan; Ersoy, Özgür; Yay, Kerem; Hijazi, Alaa; Katırcıoğlu, Salih Fehmi

doi:10.1007/s11748-008-0301-4

Cited by 18 publications

(5 citation statements)

References 11 publications

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“…Levosimendan improves RV-PA coupling in experimental acute RV failure [187-189] more than dobutamine [188]. These effects have been shown clinically with improvements in RV function and reduction in PVR in ischemic RV failure [190-194], ARDS [195], and after mitral valve replacement surgery [196,197]. In chronic PH, repetitive doses reduce mPAP and PVR from baseline and improve SvO 2 [198].…”

Section: Resultsmentioning

confidence: 99%

Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review

et al. 2010

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IntroductionPulmonary vascular dysfunction, pulmonary hypertension (PH), and resulting right ventricular (RV) failure occur in many critical illnesses and may be associated with a worse prognosis. PH and RV failure may be difficult to manage: principles include maintenance of appropriate RV preload, augmentation of RV function, and reduction of RV afterload by lowering pulmonary vascular resistance (PVR). We therefore provide a detailed update on the management of PH and RV failure in adult critical care.MethodsA systematic review was performed, based on a search of the literature from 1980 to 2010, by using prespecified search terms. Relevant studies were subjected to analysis based on the GRADE method.ResultsClinical studies of intensive care management of pulmonary vascular dysfunction were identified, describing volume therapy, vasopressors, sympathetic inotropes, inodilators, levosimendan, pulmonary vasodilators, and mechanical devices. The following GRADE recommendations (evidence level) are made in patients with pulmonary vascular dysfunction: 1) A weak recommendation (very-low-quality evidence) is made that close monitoring of the RV is advised as volume loading may worsen RV performance; 2) A weak recommendation (low-quality evidence) is made that low-dose norepinephrine is an effective pressor in these patients; and that 3) low-dose vasopressin may be useful to manage patients with resistant vasodilatory shock. 4) A weak recommendation (low-moderate quality evidence) is made that low-dose dobutamine improves RV function in pulmonary vascular dysfunction. 5) A strong recommendation (moderate-quality evidence) is made that phosphodiesterase type III inhibitors reduce PVR and improve RV function, although hypotension is frequent. 6) A weak recommendation (low-quality evidence) is made that levosimendan may be useful for short-term improvements in RV performance. 7) A strong recommendation (moderate-quality evidence) is made that pulmonary vasodilators reduce PVR and improve RV function, notably in pulmonary vascular dysfunction after cardiac surgery, and that the side-effect profile is reduced by using inhaled rather than systemic agents. 8) A weak recommendation (very-low-quality evidence) is made that mechanical therapies may be useful rescue therapies in some settings of pulmonary vascular dysfunction awaiting definitive therapy.ConclusionsThis systematic review highlights that although some recommendations can be made to guide the critical care management of pulmonary vascular and right ventricular dysfunction, within the limitations of this review and the GRADE methodology, the quality of the evidence base is generally low, and further high-quality research is needed.

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Section: Resultsmentioning

confidence: 99%

Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review

et al. 2010

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“…60 In case reports levosimendan shows a clear benefit during mitral valve surgery in patients with severe PH by reducing pulmonary artery pressure (PAP) and protecting RV contractility. 61,62 However, in another case report of patients with idiopathic pulmonary arterial hypertension, levosimendan failed to reduce PAP. 63 Levosimendan has been shown to be superior to dobutamine in some patient groups: in children with PH undergoing cardiac surgery 64 and in patients with biventricular failure levosimendan improves ejection fraction and tricuspid annular plane systolic excursion, decreasing systolic PAP.…”

Section: Right Ventricular Dysfunction and Pulmonary Hypertensionmentioning

confidence: 99%

Levosimendan: The current situation and new prospects

Moreno

Tavares-Silva

Lourenço

et al. 2014

Revista Portuguesa de Cardiologia

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Levosimendan is a pyridazinone-dinitrile derivative with positive inotropic and vasodilatory effects that has beneficial effects on myocardial performance. In previous randomized studies levosimendan improved hemodynamics and clinical course, but its effect on prognosis is still unclear. This important issue has limited its use. Although primarily used in the management of acute heart failure syndromes, this new inotropic agent may play a role in other clinical conditions. This review aims to summarize current knowledge on levosimendan and to present future prospects for the use of this drug.

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“…Levosimendan decreases PVR and improves right-ventricular output in adult patients with right-ventricular failure secondary to several conditions, including PH. [259][260][261][262][263] The role of vasopressors is to increase systemic vascular resistance to augment right-ventricular output by increasing left-ventricular systolic pressure, and to maintain right coronary perfusion. Norepinephrine has been validated as a useful agent in several animal studies.…”

Section: Support Of Right-ventricular Functionmentioning

confidence: 99%

“…[269][270][271][272][273][274] Finally, atrial septostomy as a part of the management of chronic PH has been advocated to allow for decompression of the right ventricle due to right-to-left shunting. 262,[275][276][277][278][279][280] Severe hypoxemia with this approach remains a concern. Recently, Labombarda and colleagues described favorable results with the placement of a Potts anastomosis (descending aorta to left pulmonary artery) in 2 children with severe idiopathic PH, thereby directing desaturated blood to the lower body.…”

Section: Support Of Right-ventricular Functionmentioning

confidence: 99%

Advances in the Management of Pediatric Pulmonary Hypertension

2011

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Pulmonary hypertension is a rare disease in neonates, infants, and children, and is associated with substantial morbidity and mortality. An adequate understanding of the controlling pathophysiologic mechanisms is lacking. Moreover, a minority of research is focused specifically on neonatal and pediatric populations. Although therapeutic options have increased over the past several decades, they remain limited. In advanced pulmonary hypertension, progressive pulmonary vascular functional and structural changes ultimately cause increased pulmonary vascular impedance, rightventricular failure, and death. Management includes the prevention and/or treatment of active pulmonary vasoconstriction, the support of right-ventricle function, treatment of the underlying disease (if possible), and the promotion of regressive remodeling of structural pulmonary vascular changes. Most currently available therapies augment or inhibit factors, or mediators of their downstream signaling cascades, that originate in the pulmonary vascular endothelium. These pathways include nitric-oxide/cyclic guanosine monophosphate (cGMP), prostacyclin, and endothelin-1. The ability to reverse advanced structural changes remains an as yet unattained goal. This paper reviews the epidemiology, pathophysiology, current treatments, and emerging therapies related to neonatal and pediatric pulmonary hypertension.

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Levosimendan and severe pulmonary hypertension during open heart surgery

Cited by 18 publications

References 11 publications

Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review

Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review

Levosimendan: The current situation and new prospects

Advances in the Management of Pediatric Pulmonary Hypertension

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