Effect of Levosimendan on Low Cardiac Output Syndrome in Patients With Low Ejection Fraction Undergoing Coronary Artery Bypass Grafting With Cardiopulmonary Bypass

Cholley, Bernard; Caruba, Thibaut; Grosjean, Sandrine; Amour, Julien; Ouattara, Alexandre; Villacorta, Judith; Miguet, B; Guinet, P; Lévy, François; Squara, Pierre; Hamou, Nora Aït; Carillon, Aude; Boyer, Julie; Boughenou, Marie-Fazia; Rosier, Sébastien; Robin, Emmanuel; Radutoiu, Mihail; Durand, M.; Guidon, C.; Desebbe, Olivier; Charles-Nelson, Anaïs; Menasché, Philippe; Rozec, Bertrand; Girard, Claude; Fellahi, Jean-Luc; Pirracchio, Romain; Châtellier, Gilles

doi:10.1001/jama.2017.9973

Cited by 154 publications

(128 citation statements)

References 31 publications

(75 reference statements)

Supporting

Mentioning

112

Contrasting

Unclassified

Order By: Relevance

“…After baseline data evaluation, levosimendan was administered intravenously at the dose of 0.1 µg/kg/min without a loading dose, which is adopted in the ICU for the treatment of cardiogenic shock or low cardiac output patients [34,35]. In all patients, vasopressor support was implemented by epinephrine (0.01-0.1 µg/kg/min) and in one patient with dopamine (2 µg/kg/min), as well.…”

Section: Methodsmentioning

confidence: 99%

Levosimendan Improves Oxidative Balance in Cardiogenic Shock/Low Cardiac Output Patients

Grossini¹,

Farruggio²,

Pierelli

et al. 2020

JCM

View full text Add to dashboard Cite

The beneficial effects exerted by levosimendan against cardiac failure could be related to the modulation of oxidative balance. We aimed to examine the effects of levosimendan in patients with cardiogenic shock or low cardiac output on cardiac systo-diastolic function and plasma oxidants/antioxidants (glutathione, GSH; thiobarbituric acid reactive substances, TBARS). In four patients undergoing coronary artery bypass grafting or angioplasty, cardiovascular parameters and plasma GSH and TBARS were measured at T0 (before levosimendan infusion), T1 (1 h after the achievement of the therapeutic dosage of levosimendan), T2 (end of levosimendan infusion), T3 (72 h after the end of levosimendan infusion), and T4 (end of cardiogenic shock). We found an improvement in the indices of systolic (ejection fraction, cardiac output, cardiac index) and diastolic (E to early diastolic mitral annular tissue velocity, E/'; early to late diastolic transmitral flow velocity, EA) cardiac function at early T2. A reduction of central venous pressure and pulmonary wedge pressure was also observed. Plasma levels of GSH and TBARS were restored by levosimendan at T1, as well. The results obtained indicate that levosimendan administration can regulate oxidant/antioxidant balance as an early effect in cardiogenic shock/low cardiac output patients. Modulation of oxidative status on a mitochondrial level could thus play a role in exerting the cardio-protection exerted by levosimendan in these patients.

show abstract

Section: Methodsmentioning

confidence: 99%

Levosimendan Improves Oxidative Balance in Cardiogenic Shock/Low Cardiac Output Patients

Grossini¹,

Farruggio²,

Pierelli

et al. 2020

JCM

View full text Add to dashboard Cite

show abstract

“…None of our other predefined patient‐important outcome measures have been assessed. In the recently published LEVO‐CTS, CHEETAH, and LICORN trials44, 45, 46 no difference in outcome between levosimendan and placebo in patients undergoing planned cardiac surgery was found. Of note, levosimendan was studied as a second‐line inotropic agent in these trials, and other inotropic drugs, such as dobutamine, were permitted.…”

Section: Resultsmentioning

confidence: 98%

Scandinavian SSAI clinical practice guideline on choice of inotropic agent for patients with acute circulatory failure

Møller

Granholm

Junttila

et al. 2018

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

BackgroundAdult critically ill patients often suffer from acute circulatory failure and those with low cardiac output may be treated with inotropic agents. The aim of this Scandinavian Society of Anaesthesiology and Intensive Care Medicine guideline was to present patient‐important treatment recommendations on this topic.MethodsThis guideline was developed according to GRADE. We assessed the following subpopulations of patients with shock: (1) shock in general, (2) septic shock, (3) cardiogenic shock, (4) hypovolemic shock, (5) shock after cardiac surgery, and (6) other types of shock, including vasodilatory shock. We assessed patient‐important outcome measures, including mortality and serious adverse reactions.ResultsFor all patients, we suggest against the routine use of any inotropic agent, including dobutamine, as compared to placebo/no treatment (very low quality of evidence). For patients with shock in general, and in those with septic and other types of shock, we suggest using dobutamine rather than levosimendan or epinephrine (very low quality of evidence). For patients with cardiogenic shock and in those with shock after cardiac surgery, we suggest using dobutamine rather than milrinone (very low quality of evidence). For the other clinical questions, we refrained from giving any recommendations or suggestions.ConclusionsWe suggest against the routine use of any inotropic agent in adult patients with shock. If used, we suggest using dobutamine rather than other inotropic agents for the majority of patients, however, the quality of evidence was very low, implying high uncertainty on the balance between the benefits and harms of inotropic agents.

show abstract

“…Promising results were indeed shown in meta-analyses of RCTs in patients with or at risk for AKI receiving levosimendan [85,86]. However, three recent mRCTs in cardiac surgery setting failed to demonstrate an improvement in renal outcome associated with levosimendan use, either as "prophylactic" measure in high-risk patients [87,88] or as "therapeutic" measure in patients with established postoperative cardiovascular dysfunction [89].…”

Section: Levosimendanmentioning

confidence: 99%

Perioperative Renal Pharmacological Protection During Cardiovascular Surgery

Belletti

Licheri

Bove

2019

Visceral Vessels and Aortic Repair

View full text Add to dashboard Cite

Effect of Levosimendan on Low Cardiac Output Syndrome in Patients With Low Ejection Fraction Undergoing Coronary Artery Bypass Grafting With Cardiopulmonary Bypass

Abstract: EudraCT Number: 2012-000232-25; clinicaltrials.gov Identifier: NCT02184819.

Cited by 154 publications

References 31 publications

Levosimendan Improves Oxidative Balance in Cardiogenic Shock/Low Cardiac Output Patients

Levosimendan Improves Oxidative Balance in Cardiogenic Shock/Low Cardiac Output Patients

Scandinavian SSAI clinical practice guideline on choice of inotropic agent for patients with acute circulatory failure

Perioperative Renal Pharmacological Protection During Cardiovascular Surgery

Contact Info

Product

Resources

About