Inhaled levosimendan versus intravenous levosimendan in patients with pulmonary hypertension undergoing mitral valve replacement

Abstract

Context:Inhaled levosimendan may act as selective pulmonary vasodilator and avoid systemic side effects of intravenous levosimendan, which include decrease in systemic vascular resistance (SVR) and systemic hypotension, but with same beneficial effect on pulmonary artery pressure (PAP) and right ventricular (RV) function.Aim:The aim of this study was to compare the effect of inhaled levosimendan with intravenous levosimendan in patients with pulmonary hypertension undergoing mitral valve replacement.Settings and Design:The present prospective randomized comparative study was conducted in a tertiary care hospital.Subjects and Methods:Fifty patients were randomized into two groups (n = 25). Group A: Levosimendan infusion was started immediately after coming-off of cardiopulmonary bypass and continued for 24 h at 0.1 mcg/kg/min. Group B: Total dose of levosimendan which would be given through intravenous route over 24 h was calculated and then divided into four equal parts and administered through inhalational route 6th hourly over 24 h. Hemodynamic profile (pulse rate, mean arterial pressure, pulmonary artery systolic pressure [PASP], SVR) and RV function were assessed immediately after shifting, at 1, 8, 24, and 36 h after shifting to recovery.Statistical Analysis Used:Intragroup analysis was done using paired student t-test, and unpaired student t-test was used for analysis between two groups.Results:PASP and RV-fractional area change (RV-FAC) were comparable in the two groups at different time intervals. There was a significant reduction in PASP and significant improvement in RV-FAC with both intravenous and inhalational levosimendan. SVR was significantly decreased with intravenous levosimendan, but no significant decrease in SVR was observed with inhalational levosimendan.Conclusions:Inhaled levosimendan is a selective pulmonary vasodilator. It causes decrease in PAP and improvement in RV function, without having a significant effect on SVR.

Regional analgesia in cardiothoracic surgery: A changing paradigm toward opioid-free anesthesia?

“…have used bilateral ESB to provide postoperative analgesia after cardiac surgery through midsternotomy. They observed significantly improved pain scores at rest and during coughing in patients who received ESB for up to 48 h.[ 12 ]…”

Breaking Boundaries: Novel Effects of Levosimendan in Various Diseases

“…They found that pulmonary artery pressure was significantly reduced in both milrinone and levosimendan groups compared to the placebo. Moreover, levosimendan exerted prolonged pulmonary vasodilatory effects (3 hours vs. milrinone's 30 minutes), and both agents selectively dilated pulmonary vasculature without adverse effects [33].…”

Monitoring of Levosimendan Administration in Patients with Pulmonary Hypertension Undergoing Cardiac Surgery and Effect of Two Different Dosing Schemes on Hemodynamic and Echocardiographic Parameters

“…Given the vasodilatory properties of LS, it could distend pulmonary vasculature and vasculature of the venous system, causing a reduction in both RV preload and afterload, while, given the inotropic action of the drug, it could enhance RV contractility [ 32 , 33 ]. Although LS is a potentially favorable agent in treating PH and associated RVF, few data exist regarding its use in patients with PH undergoing cardiac surgery and the impact of extracorporeal circulation on its pharmacokinetic and pharmacodynamic properties.…”