Effect of levosimendan on hemodynamic changes in patients undergoing off-pump coronary artery bypass grafting: A randomized controlled study

Kodalli, Rajesh Kumar; Sundar, Ayya Syama; Vakamudi, Mahesh; Ravulapali, Harish; Nandipati, Sushma; Chandrasekaran, Nivash; Karthekeyan, Ranjith Baskar

doi:10.4103/0971-9784.109737

Cited by 15 publications

(3 citation statements)

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“…Additionally, Treskatsch et al [ 18 ] and Qiang et al [ 9 ] reported that the levosimendan group experienced shorter durations of ICU stay and mechanical ventilation. However, Kodalli et al [ 19 ], in their double-blind, randomized study involving 30 patients, failed to identify significant differences in ventilation duration and ICU stay. Overall, the accumulated evidence underscores the potential benefits of levosimendan in improving postoperative lung function and reducing ICU-related interventions, although further research is warranted to fully elucidate its impact in diverse clinical contexts.…”

Section: Discussionmentioning

confidence: 99%

The Perioperative Use of Levosimendan as a Means of Optimizing the Surgical Outcome in Patients with Severe Heart Insufficiency Undergoing Cardiac Surgery

Leivaditis,

Grapatsas,

Papaporfyriou

et al. 2023

JCDD

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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.

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Section: Discussionmentioning

confidence: 99%

The Perioperative Use of Levosimendan as a Means of Optimizing the Surgical Outcome in Patients with Severe Heart Insufficiency Undergoing Cardiac Surgery

Leivaditis,

Grapatsas,

Papaporfyriou

et al. 2023

JCDD

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“…In this study, systemic vascular resistance index during the weaning from CPB was lower in both groups and epinephrine group showed a lower systemic vascular resistance index when compared to levosimendan group in the post-CPB period. Inodilation action of levosimendan can frequently lead to reduction in systemic vascular resistance by phosphodiesterase type III inhibition, open ATP-sensitive K + channels and nitric oxide release [ 2 , 26 , 26 , 40 ]. In the present study, even with optimal loading conditions, to avoid systemic arterial hypotension we used a continuous infusion of norepinephrine when mean arterial pressure remained below 60 mmHg; thus, levosimendan group required more norepinephrine than epinephrine group (epinephrine group: 16% vs. levosimendan group: 47%; p = 0.001) [ 2 , 5 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

“…Inodilation action of levosimendan can frequently lead to reduction in systemic vascular resistance by phosphodiesterase type III inhibition, open ATP-sensitive K + channels and nitric oxide release [ 2 , 26 , 26 , 40 ]. In the present study, even with optimal loading conditions, to avoid systemic arterial hypotension we used a continuous infusion of norepinephrine when mean arterial pressure remained below 60 mmHg; thus, levosimendan group required more norepinephrine than epinephrine group (epinephrine group: 16% vs. levosimendan group: 47%; p = 0.001) [ 2 , 5 , 40 ]. Therefore, increase in systemic vascular resistance index in levosimendan group compared with epinephrine group at post-CPB period might have been caused by the higher amount of norepinephrine administered in levosimendan group.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Blinded Study of the Left Ventricular Myocardial Performance Index Comparing Epinephrine to Levosimendan following Cardiopulmonary Bypass

Filho

Barral²,

Barrucand

et al. 2015

PLoS ONE

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BackgroundThe objective was to evaluate the effect of epinephrine and levosimendan on the left ventricle myocardial performance index in patients undergoing on-pump coronary artery by-pass grafting (CABG).MethodsIn a double-blind, randomized clinical trial, 81 patients (age: 45–65 years) of both genders were randomly divided to receive either epinephrine at a dosage of 0.06 mcg.kg1.min-1 (epinephrine group, 39 patients) or levosimendan at 0.2 mcg.kg1.min-1 (levosimendan group, 42 patients) during the rewarming of cardiopulmonary by-pass (CPB). Hemodynamic data were collected 30 minutes after tracheal intubation, before chest open (pre-CPB) and 10 minutes after termination of protamine (post-CPB). As the primary outcome, we evaluated the left ventricle myocardial performance index by the Doppler echocardiography. The myocardial performance index is the sum of the isovolumetric contraction time and the isovolumetric relaxation time, divided by the ejection time. Secondary outcomes were systolic and diastolic evaluations of the left ventricle and postoperative troponin I and MB-CK levels.ResultsOf the 81 patients allocated to the research, we excluded 2 patients in the epinephrine group and 6 patients in the levosimendan group because they didn’t wean from CPB in the first attempt. There was no statistical difference between the groups in terms of patient characteristics, risk factors, or CPB time. The epinephrine group had a lower left ventricle myocardial performance index (p = 0.0013), higher cardiac index (p = 0.03), lower systemic vascular resistance index (p = 0.01), and higher heart rate (p = 0.04) than the levosimendan group at the post-CPB period. There were no differences between the groups in diastolic dysfunction. The epinephrine group showed higher incidence of weaning from CPB in the first attempt (95% vs 85%, p = 0.0001) when compared to the levosimendan group and the norepinephrine requirement was higher in the levosimenandan group than epinephrine group (16% vs. 47%; p = 0.005) in post-CPB period. Twenty-four hours after surgery, the plasma levels of troponin I (epinephrine group: 4.5 ± 5.7 vs. levosimendan group: 2.5 ± 3.2 g/dl; p = 0.09) and MB-CK (epinephrine group: 50.7 ± 31 vs. levosimendan group: 37 ± 17.6 g/dl; p = 0.08) were not significantly different between the two groups.ConclusionWhen compared to levosimendan, patients treated with epinephrine had a lower left ventricle myocardial performance index in the immediate post-CPB period, encouraging an efficient weaning from CPB in patients undergoing on-pump CABG.Trial RegistrationClinicalTrials.gov NCT01616069

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Reducing Mortality in the Perioperative Period

Landoni

Ruggeri

Zangrillo

2014

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Effect of levosimendan on hemodynamic changes in patients undergoing off-pump coronary artery bypass grafting: A randomized controlled study

Abstract: Levosimendan significantly increased CI and decreased SVRI after OPCAB but it did not show any outcome benefit in terms of duration of ventilation and intensive care unit stay.

Cited by 15 publications

References 4 publications

The Perioperative Use of Levosimendan as a Means of Optimizing the Surgical Outcome in Patients with Severe Heart Insufficiency Undergoing Cardiac Surgery

The Perioperative Use of Levosimendan as a Means of Optimizing the Surgical Outcome in Patients with Severe Heart Insufficiency Undergoing Cardiac Surgery

A Randomized Blinded Study of the Left Ventricular Myocardial Performance Index Comparing Epinephrine to Levosimendan following Cardiopulmonary Bypass

Reducing Mortality in the Perioperative Period

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