1
|
Leivaditis V, Grapatsas K, Papaporfyriou A, Galanis M, Koletsis E, Charokopos N, Haussmann E, Kaplunov V, Papatriantafyllou A, Dahm M. The Perioperative Use of Levosimendan as a Means of Optimizing the Surgical Outcome in Patients with Severe Heart Insufficiency Undergoing Cardiac Surgery. J Cardiovasc Dev Dis 2023; 10:332. [PMID: 37623345 PMCID: PMC10455812 DOI: 10.3390/jcdd10080332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Postoperative myocardial dysfunction following cardiac surgery is a relatively common occurrence. Levosimendan, a calcium sensitizer and inotropic drug, has shown potential in improving outcomes for patients with low preoperative ejection fraction (EF) and myocardial dysfunction after cardiac surgery. This study aims to evaluate the efficacy of levosimendan in optimizing the surgical outcome for such patients. METHODS A retrospective analysis was conducted on 314 patients with preoperative severe heart failure who underwent cardiac surgery. Among them, 184 patients received perioperative adjunctive therapy with levosimendan, while a comparable group of 130 patients received conventional treatment. RESULTS The use of levosimendan demonstrated several advantages in postoperative outcomes. It significantly improved short- and long-term survival rates after cardiac surgery, enhanced hemodynamic stability, reduced the requirement for inotropic support, and facilitated faster weaning from ventilator support. Patients who received levosimendan reported reduced angina and dyspnea symptoms, as well as fewer postoperative arrhythmias. Furthermore, levosimendan helped minimize myocardial injury inevitable after cardiac surgery. The levosimendan group also exhibited a notable reduction in hospital readmissions. CONCLUSIONS This study provides evidence of several benefits associated with the perioperative use of levosimendan. However, further prospective randomized studies are warranted to standardize and comprehensively document the other perioperative therapies, in order to validate these findings and establish stronger conclusions.
Collapse
Affiliation(s)
- Vasileios Leivaditis
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, 67655 Kaiserslautern, Germany; (V.L.); (E.H.); (V.K.); (M.D.)
| | - Konstantinos Grapatsas
- Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, 45239 Essen, Germany
| | - Anastasia Papaporfyriou
- Department of Pulmonology, Internal Medicine II, Vienna University Hospital, 1090 Vienna, Austria;
| | - Michail Galanis
- Department of Thoracic Surgery, Inselspital—Bern University Hospital, University of Bern, 3012 Bern, Switzerland;
| | - Efstratios Koletsis
- Department of Cardiothoracic Surgery, University Hospital of Patras, 26504 Patras, Greece; (E.K.); (N.C.)
| | - Nikolaos Charokopos
- Department of Cardiothoracic Surgery, University Hospital of Patras, 26504 Patras, Greece; (E.K.); (N.C.)
| | - Erich Haussmann
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, 67655 Kaiserslautern, Germany; (V.L.); (E.H.); (V.K.); (M.D.)
| | - Vladislav Kaplunov
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, 67655 Kaiserslautern, Germany; (V.L.); (E.H.); (V.K.); (M.D.)
| | | | - Manfred Dahm
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, 67655 Kaiserslautern, Germany; (V.L.); (E.H.); (V.K.); (M.D.)
| |
Collapse
|
2
|
Leivaditis V, Dahm M, Papaporfyriou A, Galanis M, Koletsis E, Charokopos N, Ehle B, Papatriantafyllou A, Haussmann E, Kaplunov V, Grapatsas K. Perioperative Application of Levosimendan Optimizes Postoperative Renal Function and Organ Perfusion in Patients with Severe Heart Failure. J Cardiovasc Dev Dis 2023; 10:312. [PMID: 37504568 PMCID: PMC10380549 DOI: 10.3390/jcdd10070312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/07/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023] Open
Abstract
Background: Renal dysfunction and impaired organ perfusion are common concerns following cardiac surgery. Levosimendan, a calcium sensitizer inotropic drug, is investigated in this study for its potential to improve postoperative renal function and organ perfusion in patients with low preoperative ejection fraction and severe myocardial dysfunction after cardiac surgery. Methods: A retrospective analysis was conducted on 314 patients with preoperative heart failure who underwent cardiac surgery. Among them, 184 patients received perioperative adjunctive therapy with levosimendan, while 130 patients with similar characteristics received conventional treatment. Results: The perioperative administration of levosimendan resulted in a significantly lower need for renal replacement therapy (p < 0.001) and improvements in the serum creatinine levels, glomerular filtration rate, and creatinine clearance. Similarly, the C-reactive protein levels, blood pH, and lactic acid levels showed comparable improvements. Conclusions: The use of levosimendan was associated with a significant enhancement in postoperative renal function and a reduction in the need for renal replacement therapy. Furthermore, it resulted in a decrease in the extent of organ malperfusion. Postoperative inflammatory reactions and metabolic balance also exhibited improvements.
Collapse
Affiliation(s)
- Vasileios Leivaditis
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, 67655 Kaiserslautern, Germany
| | - Manfred Dahm
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, 67655 Kaiserslautern, Germany
| | - Anastasia Papaporfyriou
- Department of Pulmonology, Internal Medicine II, Vienna University Hospital, 1090 Vienna, Austria
| | - Michail Galanis
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
| | - Efstratios Koletsis
- Department of Cardiothoracic Surgery, University Hospital of Patras, 26504 Patras, Greece
| | - Nikolaos Charokopos
- Department of Cardiothoracic Surgery, University Hospital of Patras, 26504 Patras, Greece
| | - Benjamin Ehle
- Department of Thoracic Surgery, Asklepios Lung Clinic Munich-Gauting, 82131 Gauting, Germany
| | | | - Erich Haussmann
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, 67655 Kaiserslautern, Germany
| | - Vladislav Kaplunov
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, 67655 Kaiserslautern, Germany
| | - Konstantinos Grapatsas
- West German Lung Center, Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, University Hospital Essen, University Duisburg-Essen, 45239 Essen, Germany
| |
Collapse
|
3
|
Sheng W, Qiao H, Niu Z, Wang T, Li H, Zhang W, Wu J, Lv X. Prospective Study on the Postoperative Use of Levosimendan After Conventional Heart Valve Replacement. Med Sci Monit 2021; 27:e932001. [PMID: 34588413 PMCID: PMC8491556 DOI: 10.12659/msm.932001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background The aim of this study was to explore the effect of levosimendan in patients after heart valve replacement and its influence on postoperative recovery. Material/Methods This prospective study included 185 patients with valvular diseases undergoing conventional valve replacement. Patients were divided into 2 groups using a random number table before surgery. Patients in the levosimendan group were administrated levosimendan intravenous infusion immediately after entering the Intensive Care Unit (ICU). The left ventricular ejection fraction (LVEF), cardiac output, and heart failure-related index, such as B-type natriuretic peptide (BNP) level, were recorded at 1, 3, and 7 days after surgery. The dosage and administration time of dopamine and epinephrine, mechanical ventilation time, ICU length of stay, and postoperative adverse events were recorded. Results Cardiac output and LVEF of patients in the levosimendan group were significantly higher than those in the control group at different time points (P<0.05), and BNP level was lower than that of the control group (P<0.0001). Dosage and administration time of dopamine and epinephrine in the levosimendan group were lower than those of the control group (P<0.0001, P<0.0001, respectively). ICU length of stay and total incidence of postoperative adverse events were lower than those of the control group (P<0.0001, P=0.002, respectively). Conclusions Levosimendan administration immediately after heart valve replacement effectively improved the heart function of patients, reduced administration of vasoactive drugs, shortened length of ICU stay, reduced incidence of postoperative adverse events, and promoted recovery of patients after surgery.
Collapse
Affiliation(s)
- Wei Sheng
- Department of Cardiovascular Surgery, Qingdao Municipal Hospital, Medical College of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Hui Qiao
- Department of Cardiovascular Surgery, Qingdao Municipal Hospital, Medical College of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Zhaozhuo Niu
- Department of Cardiovascular Surgery, Qingdao Municipal Hospital, Medical College of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Tianyi Wang
- Department of Cardiovascular Surgery, Qingdao Municipal Hospital, Medical College of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Haoyou Li
- Department of Cardiovascular Surgery, Qingdao Municipal Hospital, Medical College of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Wenfeng Zhang
- Department of Cardiovascular Surgery, Qingdao Municipal Hospital, Medical College of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Jiantao Wu
- Department of Cardiovascular Surgery, Qingdao Municipal Hospital, Medical College of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Xiao Lv
- Department of Cardiovascular Surgery, Qingdao Municipal Hospital, Medical College of Qingdao University, Qingdao, Shandong, China (mainland)
| |
Collapse
|
4
|
Cubas WS, Carrion-Arcela JP, Rosadio-Portilla LG, Murillo-Pérez L, Soplopuco-Palacios C, Quiroz-Sánchez F. [Levosimendan and postcardiotomy low cardiac output syndrome: indisputable evidence or mere statistical coincidence?]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2021; 2:74-76. [PMID: 37727262 PMCID: PMC10506552 DOI: 10.47487/apcyccv.v2i1.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/01/2021] [Indexed: 09/21/2023]
Affiliation(s)
- W Samir Cubas
- Departamento de Cirugía de Tórax y Cardiovascular, Hospital Nacional Edgardo Rebagliati Martins. Lima, PerúDepartamento de Cirugía de Tórax y CardiovascularHospital Nacional Edgardo Rebagliati MartinsLimaPerú
| | - Jean Pierre Carrion-Arcela
- Departamento de Cardiología, Hospital Nacional Almanzor Aguinaga Asenjo. Chiclayo, PerúDepartamento de CardiologíaHospital Nacional Almanzor Aguinaga AsenjoChiclayoPerú
| | - Luz Gabriela Rosadio-Portilla
- Departamento de Cirugía de Tórax y Cardiovascular, Hospital Nacional Guillermo Almenara Irigoyen. Lima, PerúDepartamento de Cirugía de Tórax y CardiovascularHospital Nacional Guillermo Almenara IrigoyenLimaPerú
| | - Luis Murillo-Pérez
- Servicio de Cardiología Clínica, Instituto Nacional Cardiovascular INCOR. Lima, PerúServicio de Cardiología ClínicaInstituto Nacional Cardiovascular INCORLimaPerú
| | - Christian Soplopuco-Palacios
- Servicio de Cardiología Perioperatoria, Instituto Nacional Cardiovascular INCOR. Lima, PerúServicio de Cardiología PerioperatoriaInstituto Nacional Cardiovascular INCORLimaPerú
| | - Fabrizio Quiroz-Sánchez
- Servicio de Cardiología Perioperatoria, Instituto Nacional Cardiovascular INCOR. Lima, PerúServicio de Cardiología PerioperatoriaInstituto Nacional Cardiovascular INCORLimaPerú
| |
Collapse
|
5
|
Jawitz OK, Stebbins AS, Raman V, Alhanti B, van Diepen S, Heringlake M, Fremes S, Whitlock R, Meyer SR, Mehta RH, Stafford-Smith M, Goodman SG, Alexander JH, Lopes RD. Association between levosimendan, postoperative AKI, and mortality in cardiac surgery: Insights from the LEVO-CTS trial. Am Heart J 2021; 231:18-24. [PMID: 33127531 DOI: 10.1016/j.ahj.2020.10.066] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/23/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVES We aimed to evaluate the association between levosimendan treatment and acute kidney injury (AKI) as well as assess the clinical sequelae of AKI in cardiac surgery patients with depressed left ventricular function (ejection fraction <35%). METHODS Patients in the LEVO-CTS trial undergoing on-pump coronary artery bypass grafting (CABG), valve, or CABG/valve surgery were stratified by occurrence and severity of postoperative AKI using the AKIN classification. The association between levosimendan infusion and AKI was modeled using multivariable regression. RESULTS Among 854 LEVO-CTS patients, 231 (27.0%) experienced postoperative AKI, including 182 (21.3%) with stage 1, 35 (4.1%) with stage 2, and 14 (1.6%) with stage 3 AKI. The rate of AKI was similar between patients receiving levosimendan or placebo. The odds of 30-day mortality significantly increased by AKI stage compared to those without AKI (stage 1: adjusted odds ratio [aOR] 2.0, 95% confidence interval [CI] 0.8-4.9; stage 2: aOR 9.1, 95% CI 3.2-25.7; stage 3: aOR 12.4, 95% CI 3.0-50.4). No association was observed between levosimendan, AKI stage, and odds of 30-day mortality (interaction P = .69). Factors independently associated with AKI included increasing age, body mass index, diabetes, and increasing baseline systolic blood pressure. Increasing baseline eGFR and aldosterone antagonist use were associated with a lower risk of AKI. CONCLUSIONS Postoperative AKI is common among high-risk patients undergoing cardiac surgery and associated with significantly increased risk of 30-day death or dialysis. Levosimendan was not associated with the risk of AKI.
Collapse
|
6
|
Gayatri D, Tongers J, Efremov L, Mikolajczyk R, Sedding D, Schumann J. Prophylactic use of inotropic agents for the prevention of low cardiac output syndrome and mortality in adults undergoing cardiac surgery. Hippokratia 2020. [DOI: 10.1002/14651858.cd013781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Dwi Gayatri
- Department of Anaesthesiology and Surgical Intensive Care; Martin-Luther-University Halle-Wittenberg; Halle (Saale) Germany
| | - Jörn Tongers
- Cardiology, Angiology and Intensive Care Medicine; University Hospital Halle (Saale); Halle (Saale) Germany
| | - Ljupcho Efremov
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences; Medical School of the Martin-Luther-University Halle-Wittenberg; Halle (Saale) Germany
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences; Medical School of the Martin-Luther-University Halle-Wittenberg; Halle (Saale) Germany
| | - Daniel Sedding
- Cardiology, Angiology and Intensive Care Medicine; University Hospital Halle (Saale); Halle (Saale) Germany
| | - Julia Schumann
- Department of Anaesthesiology and Surgical Intensive Care; Martin-Luther-University Halle-Wittenberg; Halle (Saale) Germany
| |
Collapse
|
7
|
Guerrero-Orriach JL, Malo-Manso A, Ramirez-Aliaga M, Florez Vela AI, Galán-Ortega M, Moreno-Cortes I, Gonzalez-Almendros I, Ramirez-Fernandez A, Ariza-Villanueva D, Escalona-Belmonte JJ, Quesada-Muñoz G, Sepúlveda-Haro E, Romero-Molina S, Bellido-Estevez I, Gomez-Luque A, Rubio-Navarro M, Alcaide-Torres J, Santiago-Fernandez C, Garrido-Sanchez L, Cruz-Mañas J. Renal and Neurologic Benefit of Levosimendan vs Dobutamine in Patients With Low Cardiac Output Syndrome After Cardiac Surgery: Clinical Trial FIM-BGC-2014-01. Front Pharmacol 2020; 11:1331. [PMID: 32982742 PMCID: PMC7479222 DOI: 10.3389/fphar.2020.01331] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 08/10/2020] [Indexed: 12/19/2022] Open
Abstract
Background Low-cardiac output syndrome (LCOS) after cardiac surgery secondary to systemic hypoperfusion is associated with a higher incidence of renal and neurological damage. A range of effective therapies are available for LCOS. The beneficial systemic effects of levosimendan persist even after cardiac output is restored, which suggests an independent cardioprotective effect. Methods A double-blind clinical trial was conducted in patients with a confirmed diagnosis of LCOS randomized into two treatment groups (levosimendan vs. dobutamine). Monitoring of hemodynamic (cardiac index, systolic volume index, heart rate, mean arterial pressure, central venous pressure, central venous saturation); biochemical (e.g. creatinine, S100B protein, NT-proBNP, troponin I); and renal parameters was performed using acute kidney injury scale (AKI scale) and renal and brain ultrasound measurements [vascular resistance index (VRI)] at diagnosis and during the first 48 h. Results Significant differences were observed between groups in terms of cardiac index, systolic volume index, NT-proBNP, and kidney injury stage at diagnosis. In the levosimendan group, there were significant variations in AKI stage after 24 and 48 h. No significant differences were observed in the other parameters studied. Conclusion Levosimendan showed a beneficial effect on renal function in LCOS patients after cardiac surgery that was independent from cardiac output and vascular tone. This effect is probably achieved by pharmacological postconditioning. Clinical Trial Registration EUDRA CT, identifier 2014-001461-27. https://www.clinicaltrialsregister.eu/ctr-search/search?query=2014-001461-27.
Collapse
Affiliation(s)
- Jose L Guerrero-Orriach
- Institute of Biomedical Research in Malaga [IBIMA], Malaga, Spain.,Department of Anaesthesiology, Virgen de la Victoria University Hospital, Malaga, Spain.,Department of Pharmacology and Pediatrics, School of Medicine, University of Malaga, Malaga, Spain
| | - Alfredo Malo-Manso
- Institute of Biomedical Research in Malaga [IBIMA], Malaga, Spain.,Department of Anaesthesiology, Virgen de la Victoria University Hospital, Malaga, Spain
| | - Marta Ramirez-Aliaga
- Institute of Biomedical Research in Malaga [IBIMA], Malaga, Spain.,Department of Anaesthesiology, Virgen de la Victoria University Hospital, Malaga, Spain
| | | | - Manuel Galán-Ortega
- Institute of Biomedical Research in Malaga [IBIMA], Malaga, Spain.,Department of Anaesthesiology, Virgen de la Victoria University Hospital, Malaga, Spain
| | - Isabel Moreno-Cortes
- Department of Anaesthesiology, Virgen de la Victoria University Hospital, Malaga, Spain
| | | | - Alicia Ramirez-Fernandez
- Institute of Biomedical Research in Malaga [IBIMA], Malaga, Spain.,Department of Anaesthesiology, Virgen de la Victoria University Hospital, Malaga, Spain
| | | | - Juan Jose Escalona-Belmonte
- Institute of Biomedical Research in Malaga [IBIMA], Malaga, Spain.,Department of Anaesthesiology, Virgen de la Victoria University Hospital, Malaga, Spain
| | - Guillermo Quesada-Muñoz
- Institute of Biomedical Research in Malaga [IBIMA], Malaga, Spain.,Department of Anaesthesiology, Virgen de la Victoria University Hospital, Malaga, Spain
| | | | | | - Inmaculada Bellido-Estevez
- Institute of Biomedical Research in Malaga [IBIMA], Malaga, Spain.,Department of Pharmacology and Pediatrics, School of Medicine, University of Malaga, Malaga, Spain
| | - Aurelio Gomez-Luque
- Institute of Biomedical Research in Malaga [IBIMA], Malaga, Spain.,Department of Anaesthesiology, Virgen de la Victoria University Hospital, Malaga, Spain.,Department of Pharmacology and Pediatrics, School of Medicine, University of Malaga, Malaga, Spain
| | - Manuel Rubio-Navarro
- Department of Anaesthesiology, Virgen de la Victoria University Hospital, Malaga, Spain
| | - Juan Alcaide-Torres
- Institute of Biomedical Research in Malaga [IBIMA], Malaga, Spain.,Unidad de Gestión Clínica de Endocrinología y Nutrición, Virgen de la Victoria University Hospital, Málaga, Spain
| | - Concepcion Santiago-Fernandez
- Institute of Biomedical Research in Malaga [IBIMA], Malaga, Spain.,Unidad de Gestión Clínica de Endocrinología y Nutrición, Virgen de la Victoria University Hospital, Málaga, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición-CIBEROBN, Instituto de Salud Carlos III, Málaga, Spain
| | - Lourdes Garrido-Sanchez
- Institute of Biomedical Research in Malaga [IBIMA], Malaga, Spain.,Unidad de Gestión Clínica de Endocrinología y Nutrición, Virgen de la Victoria University Hospital, Málaga, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición-CIBEROBN, Instituto de Salud Carlos III, Málaga, Spain
| | - Jose Cruz-Mañas
- Department of Anaesthesiology, Virgen de la Victoria University Hospital, Malaga, Spain
| |
Collapse
|
8
|
Terbeck S, Heinisch PP, Lenz A, Friess JO, Guensch D, Carrel T, Eberle B, Erdoes G. Levosimendan and systemic vascular resistance in cardiac surgery patients: a systematic review and meta-analysis. Sci Rep 2019; 9:20343. [PMID: 31889123 PMCID: PMC6937247 DOI: 10.1038/s41598-019-56831-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 12/16/2019] [Indexed: 12/11/2022] Open
Abstract
AbstractLevosimendan is a potent non-adrenergic inodilator agent. The net effect of hemodynamic changes may result in a hyperdynamic state with low systemic vascular resistance. We conducted a systematic review and meta-analysis assessing hemodynamics in cardiac surgery patients treated with levosimendan. English-language literature was searched systematically from 2006 until October 2018, including randomized controlled trials and case-matched or retrospective studies providing at least two sequentially measured hemodynamic variables in adult patients who underwent cardiac surgery with cardiopulmonary bypass and were treated with levosimendan in comparison to alternative drugs or devices. Cardiac index significantly increased in the levosimendan group by 0.74 (0.24 to 1.23) [standardized mean difference (95% CI); p = 0.003] from baseline to postoperative day (POD) 1, and by 0.75 (0.25 to 1.25; p = 0.003) from baseline to POD 7, when corrected for the standardized mean difference at baseline by a multivariate mixed effects meta-analysis model. With this correction for baseline differences, other hemodynamic variables including systemic vascular resistance did not significantly differ until POD 1 [−0.17 (−0.64 to 0.30), p = 0.48] and POD 7 [−0.13 (−0.61 to 0.34), p = 0.58] between the levosimendan and the comparator group. Levosimendan increases cardiac index in patients undergoing cardiac surgery. Although levosimendan has inodilator properties, this meta-analysis finds no clinical evidence that levosimendan produces vasopressor-resistant vasoplegic syndrome.
Collapse
|
9
|
Rodríguez-González R, Pollesello P, Baluja A, Álvarez J. Effects of Levosimendan on Inflammation and Oxidative Stress Pathways in a Lipopolysaccharide-Stimulated Human Endothelial Cell Model. Biol Res Nurs 2019; 21:466-472. [PMID: 31272201 DOI: 10.1177/1099800419861694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Levosimendan is a myocardial Ca2+ sensitizer and opener of ATP-dependent potassium channels with inotropic, vasodilating, and cardioprotective properties. It was originally developed for the treatment of acute decompensated heart failure, but its complex mechanism of action means that it could also play a role in organ protection in response to infection. Using an in vitro approach, we explored whether levosimendan administration influenced cell responses to lipopolysaccharide (LPS). Primary human umbilical vein endothelial cells were stimulated with 1 µg/ml LPS from Escherichia coli (E. coli). Cells were treated with levosimendan at 0, 0.1, 1, or 10 µM 3 hr later. Samples were taken 24 hr after treatment to measure cell necrosis, apoptosis, pro-inflammatory mediators (interleukin 6 [IL-6] and toll-like receptor 4 [TLR4]), and oxidative stress (total reactive oxygen species/reactive nitrogen species [ROS/RNS]). Levosimendan at 1 and 10 µM protected against LPS-induced endothelial cell death and reduced TLR4 expression (p < .05). All doses reduced levels of IL-6 and ROS/RNS (p < .05). Findings suggest that levosimendan may exert protective effects against endothelial cell death in this model via attenuation of inflammation and oxidative stress pathways. Future studies might explore the potential beneficial role of levosimendan in modulating molecular mechanisms triggered by infections.
Collapse
Affiliation(s)
- Raquel Rodríguez-González
- 1 Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, School of Nursing, University of Santiago de Compostela, Santiago de Compostela, Spain.,2 Health Research Institute of Santiago de Compostela (IDIS), Galician Health System, Clinical University Hospital, Santiago de Compostela, Spain
| | | | - Aurora Baluja
- 2 Health Research Institute of Santiago de Compostela (IDIS), Galician Health System, Clinical University Hospital, Santiago de Compostela, Spain.,4 Department of Surgery, School of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Julián Álvarez
- 2 Health Research Institute of Santiago de Compostela (IDIS), Galician Health System, Clinical University Hospital, Santiago de Compostela, Spain.,4 Department of Surgery, School of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| |
Collapse
|
10
|
Vally S, Ferdynus C, Persichini R, Bouchet B, Braunberger E, Lo Pinto H, Martinet O, Vandroux D, Aujoulat T, Allyn J, Allou N. Impact of levosimendan on weaning from peripheral venoarterial extracorporeal membrane oxygenation in intensive care unit. Ann Intensive Care 2019; 9:24. [PMID: 30707314 PMCID: PMC6358626 DOI: 10.1186/s13613-019-0503-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/29/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Few data are available on the impact of levosimendan in refractory cardiogenic shock patients undergoing peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO). The aim of this study was to evaluate the impact of levosimendan on VA-ECMO weaning in patients hospitalized in intensive care unit (ICU). METHODS This retrospective cohort study was conducted in a French university hospital from 2010 to 2017. All patients hospitalized in ICU undergoing VA-ECMO were consecutively evaluated. RESULTS A total of 150 patients undergoing VA-ECMO were eligible for the study. Thirty-eight propensity-matched patients were evaluated in the levosimendan group and 65 in the non-levosimendan group. In patients treated with levosimendan, left ventricular ejection fraction had increased from 21.5 ± 9.1% to 30.7 ± 13.5% (P < 0.0001) and aortic velocity-time integral from 8.9 ± 4 cm to 12.5 ± 3.8 cm (P = 0.002) 24 h after drug infusion. After propensity score matching, levosimendan was the only factor associated with a significant reduction in VA-ECMO weaning failure rates (hazard ratio = 0.16; 95% confidence interval 0.04-0.7; P = 0.01). Kaplan-Meier survival curves showed that survival rates at 30 days were 78.4% for the levosimendan group and 49.5% for the non-levosimendan group (P = 0.02). After propensity score matching analysis, the difference in 30-day mortality between the two groups was not significant (hazard ratio = 0.55; 95% confidence interval 0.27-1.10; P = 0.09). CONCLUSIONS Our results suggest that levosimendan was associated with a beneficial effect on VA-ECMO weaning in ICU patients.
Collapse
Affiliation(s)
- Shamir Vally
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France
| | - Cyril Ferdynus
- Unité de Soutien Méthodologique, CHU de La Réunion, Saint-Denis, France.,INSERM, CIC 1410, Saint-Pierre, France
| | - Romain Persichini
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France
| | - Bruno Bouchet
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France
| | - Eric Braunberger
- Chirurgie cardiaque, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France
| | - Hugo Lo Pinto
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France
| | - Olivier Martinet
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France
| | - David Vandroux
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France
| | - Thomas Aujoulat
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France
| | - Jérôme Allyn
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France
| | - Nicolas Allou
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France. .,Réanimation polyvalente, Hôpital Félix Guyon, Bellepierre, 97405, Saint-Denis, France.
| |
Collapse
|
11
|
Levosimendan use in patients with preoperative low ejection fraction undergoing cardiac surgery: A systematic review with meta-analysis and trial sequential analysis. J Clin Anesth 2019; 52:37-47. [DOI: 10.1016/j.jclinane.2018.08.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/13/2018] [Accepted: 08/16/2018] [Indexed: 12/20/2022]
|