A Comparison of Doubutamine and Levosimendan on Hepatic Blood Flow in Patients with a Low Cardiac Output State after Cardiac Surgery: A Randomised Controlled Study

Abstract

Liver dysfunction due to a low cardiac output state after cardiac surgery is associated with a poor prognosis, but whether one inotrope is superior to another in improving hepatic perfusion remains uncertain. This study compared the systemic and hepatic haemodynamic effects of levosimendan to dobutamine in patients with a low cardiac output state (cardiac index < 2.2 1/min/m2) after on-pump cardiac surgery. A total of 25 patients were randomised to receive either an intravenous bolus of levosimendan (12 μg/kg) over 15 minutes, followed by an infusion of 0.2 μg/kg/min for 24 hours, or an infusion of dobutamine 7.5 μg/kg/min for 24 hours and completed the study. The systemic and hepatic haemodynamics at 24 and 48 hours were all better after levosimendan than dobutamine (dobutamine group: cardiac index (1/min/m2)=2.51 [standard deviation ±0.29], 2.40±0.23; portal vein flow (ml/min): 614.0± 124.7, 585.9±144.8; pulsatility index: 2.02±0,28, 2.98±0.27 versus the levosimendan group: cardiac index: 3.02± 0.27, 2.98± 0.30; portal vein flow: 723.0± 143.5, 702.9±117.8; pulsatility index: 1.71 ±0.26,1.73 ±0.27). The improvement in portal vein blood flow at 48 hours was significantly better after levosimendan than dobutamine (41% vs. 11% increment from baseline, P<0.05). In addition, there was a significant reduction in hepatic artery resistance after levosimendan but not dobutamine (resistance index reduction 6.5% vs. 0%, P<0.05). In summary, levosimendan can be considered as a selective liver vasodilator and can improve hepatic blood flow through both the hepatic artery and portal venous system, whereas dobutamine can only improve the portal venous blood flow without vasodilating the hepatic artery.

Renal and Neurologic Benefit of Levosimendan vs Dobutamine in Patients With Low Cardiac Output Syndrome After Cardiac Surgery: Clinical Trial FIM-BGC-2014-01

“…Cardiovascular response to levosimendan vs beta-agonists (such as dobutamine) in the treatment of LCOS has been assessed in a variety of studies (Follath et al, 2002;Alvarez et al, 2013;Gandham et al, 2013;Xuan et al, 2013). The scientific literature demonstrates that levosimendan improves renal function, increases survival rates, and causes fewer side effects (Yilmaz et al, 2007;Bragadottir et al, 2013;Yilmaz et al, 2013;Baysal et al, 2014;CHEETAH Study Group, 2018;.…”

Cost-benefits of incorporating levosimendan into cardiac surgery practice: German base case

“…The clinical benefits of using levosimendan in cardiac surgery have been demonstrated in a number of studies [1,17,[36][37][38][39][40]. In the current economic analysis, which evaluated the costs of levosimendan compared with dobutamine in patients requiring inotropic support following cardiac surgery in Germany, levosimendan was found to be cost saving from the hospital and health insurance perspectives.…”

Levosimendan in the treatment of patients with acute cardiac conditions: an expert opinion of the Association of Intensive Cardiac Care of the Polish Cardiac Society

“…In comparison with dobutamine, levosimendan improved hepatic blood flow through both hepatic artery (increased arterial perfusion and reduced hepatic artery resistance) and portal venous system (increased portal vein flow and reduced portal hypertension). 89,90 Levosimendan in untypical forms of acute heart failure: takotsubo syndrome, peripartum cardiomyopathy, and β -blocker or calcium channel blocker toxicity Adrenergic agonists, such as catecholamines or phosphodiesterase inhibitors, are generally contraindicated in cardiogenic shock complicating Takotsubo syndrome. 91 Therefore, apart from temporary mechanical circulatory support, successful treatment options include also levosimendan.…”