Preoperative levosimendan in ischemic mitral valve repair

Sharma, Pranav; Malhotra, Amber; Gandhi, Sanjay; Garg, Pankaj; Bishnoi, Arvind Kumar; Gandhi, Hemang

doi:10.1177/0218492313499352

Cited by 28 publications

(18 citation statements)

References 18 publications

(17 reference statements)

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“…In a trial by Leppikangas et al [40], 24 patients were randomised to receive a 24-hour infusion of either levosimendan or placebo prior to cardiac surgery; the authors found that levosimendan was associated with improved haemodynamic markers. Similar results were noted in patients undergoing coronary artery bypass grafting with left ventricular systolic dysfunction (left ventricular ejection fraction <30%) undergoing concomitant mitral valve repair, with advantages in a decreased need for ventilator support, and ICU and hospital length of stay [47].…”

Section: Pre-operative Administrationsupporting

confidence: 68%

Peri-operative Levosimendan in Patients Undergoing Cardiac Surgery: An Overview of the Evidence

Shi

Collins

et al. 2015

Heart, Lung and Circulation

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Levosimendan, a calcium sensitiser, has recently emerged as a valuable agent in the peri-operative management of cardiac surgery patients. Levosimendan is a calcium-sensitising ionodilator. By binding to cardiac troponin C and reducing its calcium-binding co-efficient, it enhances myofilament responsiveness to calcium and thus enhances myocardial contractility without increasing oxygen demand. Current evidence suggests that levosimendan enhances cardiac function after cardiopulmonary bypass in patients with both normal and reduced left ventricular function. In addition to being used as post-operative rescue therapy for low cardiac output syndrome, a pre-operative levosimendan infusion in high risk patients with poor cardiac function may reduce inotropic requirements, the need for mechanical support, the duration of intensive care admissions as well as post-operative mortality. Indeed, it is these higher-risk patients who may experience a greater degree of benefit. Larger, multicentre randomised trials in cardiac surgery will help to elucidate the full potential of this agent.

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Section: Pre-operative Administrationsupporting

confidence: 68%

Peri-operative Levosimendan in Patients Undergoing Cardiac Surgery: An Overview of the Evidence

Shi

Collins

et al. 2015

Heart, Lung and Circulation

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“…After removal of duplicates, 423 findings were screened and 171 were excluded because they were not focused on the topic of interest. As shown in the PRISMA flow diagram in Additional file 2 , after the evaluation of the remaining 252 findings, only 6 RCTs were judged to be of interest for our quantitative analyses: 5 RCTs included only patients with preoperative severely depressed LVEF [ 13 , 19 – 22 ], and 1 RCT included both patients with preoperative severely depressed LVEF and patients with intra-/postoperative LCOS [ 14 ]. No study was focused only on patients with intra-/postoperative LCOS.…”

Section: Resultsmentioning

confidence: 99%

“…In six studies [ 13 , 14 , 19 – 22 ], both mortality and need for RRT were reported and were included in the primary outcome analysis. Mortality was similar overall (OR 0.64 [0.37, 1.11], p = 0.11, I 2 = 42%), but in the subgroup of patients with low LVEF, levosimendan showed a significantly lower mortality (OR 0.51 [0.32, 0.82], p = 0.005, I 2 = 0%) (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Researchers in five studies reported the incidence of postoperative AF and supraventricular arrhythmias, using different criteria (with a time frame of assessment not always reported) [ 13 , 14 , 20 – 22 ]. There was no difference in the incidence of postoperative AF and supraventricular arrhythmias between levosimendan and placebo, either overall (OR 0.62 [0.32, 1.18], p = 0.15, I 2 = 79%) or in the subgroup with low LVEF (OR 0.52 [0.19, 1.04], p = 0.20, I 2 = 84%).…”

Section: Resultsmentioning

confidence: 99%

“…Researchers in six studies reported the need for postoperative cardiac mechanical support [ 13 , 14 , 19 – 22 ]. There was a trend toward a lower incidence of support with levosimendan, both overall (OR 0.38 [0.13, 1.10], p = 0.07, I 2 = 82%) and in the subgroup with low LVEF (OR 0.29 [0.09, 1.00], p = 0.05, I 2 = 85%).…”

Section: Resultsmentioning

confidence: 99%

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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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Inotropic agents and vasodilator strategies for the treatment of cardiogenic shock or low cardiac output syndrome

Schümann

Henrich

Strobl

et al. 2018

Cochrane Database of Systematic Reviews

103

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Preoperative levosimendan in ischemic mitral valve repair

Abstract: Preoperative treatment with levosimendan in patients undergoing coronary artery bypass grafting and mitral valve repair resulted in improved hemodynamics and a stable postoperative course.

Cited by 28 publications

References 18 publications

Peri-operative Levosimendan in Patients Undergoing Cardiac Surgery: An Overview of the Evidence

Peri-operative Levosimendan in Patients Undergoing Cardiac Surgery: An Overview of the Evidence

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

Inotropic agents and vasodilator strategies for the treatment of cardiogenic shock or low cardiac output syndrome

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