Is There Still Room for the Prophylactic Use of Levosimendan in Cardiac Surgery?

Molfetta, Pasquale Di; Gregorini, Renato; Fiore, Corrado; Santarpino, Giuseppe

doi:10.1016/j.athoracsur.2018.05.007

Cited by 5 publications

(2 citation statements)

References 2 publications

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“…Also some of these studies included patients with normal ventricular function leaving no real action for Levosimendan in improving myocardial contractility and thus surgical outcome. [10] Our study included a larger sample size of patients with impaired LV function needing CABG surgery with or without concomitant ischemic mitral repair and receiving preoperative Levosimendan than previous similar studies which were underpowered by small patient cohort. [11] In addition, in our series we have chosen the strategy of giving Levosimandan as a continuous infusion at a rate of 0.1µg/kg/min without loading 24 hours before surgery to avoid the adverse effects of Levosimendan; namely hypotension and arrhythmias noted when giving the drug as an intravenous bolus or infusion at higher rates.…”

Section: Discussionmentioning

confidence: 99%

Effect of Levosimendan Infusion 24 Hours Before CABG Surgery in Patients with Impaired Left Ventricular Function on the Need for Postoperative IABP

Nasr¹,

Alkady²,

Saber³

et al. 2019

IJCTS

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Background: Due to their unfavorable outcome, patients with impaired left ventricular function undergoing CABG surgery (LVEF ≤ 35%) are in a real need for optimization of their preoperative status in order to achieve the best possible results. In this retrospective comparative study we analysis our results in patients with impaired LV function after using Levosimendan as a continuous infusion 24 hours prior to CABG surgery regarding the need for postoperative IABP. Patients and methods: We included in this study 103 patients with LVEF ≤ 35% that underwent coronary artery bypass grafting with or without repair of ischemic mitral regurgitation and received Levosimendan infusion 24 hours before surgery in the period between January 2016 and January 2019 in 2 hospitals (Group A). These data were compared to another matched control group of 98 patients with similar conditions that were operated in the same hospitals over a previous period of 3 years but received no Levosimendan infusion preoperatively (Group B). Results: There was a statistically significant difference in the postoperative results in favor of group A regarding the need for IABP application (P-value = 0.013). However there were no statistically significant differences between both groups in concern of duration of inotropic support (P-value = 0.40), duration of mechanical ventilation (P-value = 0.30), total ICU (P-value = 0.20) and hospital stays (P-value = 0.40), incidence of postoperative atrial fibrillation (P-value = 0.50), incidence of major adverse effects, and in-hospital mortality (P-value = 0.20). There was only one in-hospital mortality in each group. Conclusion: According to our study, infusion of Levosimendan 24 hours prior to CABG surgery in patients with impaired left ventricular contractility is safe and effective in reducing the need of IABP application. However Levosimendan infusion did not affect significantly postoperative coarse, incidence of major adverse effects, and in-hospital mortality.

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Section: Discussionmentioning

confidence: 99%

Effect of Levosimendan Infusion 24 Hours Before CABG Surgery in Patients with Impaired Left Ventricular Function on the Need for Postoperative IABP

Nasr¹,

Alkady²,

Saber³

et al. 2019

IJCTS

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“…Several investigations have been conducted to explore the role of levosimendan in perioperative cardiac surgery. It has been shown to augment contractility without increasing oxygen demand demonstrating its potential advantages, including reduced mortality and morbidity [14].…”

Section: Perioperative Use In Cardiac Surgerymentioning

confidence: 99%

Breaking Boundaries: Novel Effects of Levosimendan in Various Diseases

Zhang,

Zhao,

Liu

2024

IJDDP

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Review Breaking Boundaries: Novel Effects of Levosimendan in Various Diseases Hongyuan Zhang 1, Minxing Zhao 2, and Yanrong Liu 1,3,* 1 Michael Smith building, Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, M139PT Manchester, UK. 2 Loreto High School, Chorlt on, M217SW Manchester, UK. 3 The Department of Cardiology, the 1st Affiliated Nanjing Medical University, 300 Guangzhou Road, Nanjing, China. * Correspondence: yanrong.liu@manchester.ac.uk Received: 6 February 2024 Accepted: 23 February 2024 Published: 18 March 2024 Abstract: Levosimendan, an inodilator that has been applied in clinical use for over two decades, has transcended its initial indication in the management of acutely decompensated chronic heart failure. Over the years, it has been adopted in septic shock, perioperative use of cardiac surgery, advanced end-stage heart failure, and has shown potential for inhaled administration, highlighting its versatility. Levosimendan has diverse mechanisms of action which mediate its non-traditional uses. Ongoing research aims to expand our understanding and develop personalized treatment strategies for the use of levosimendan. The significance of levosimendan in acute decompensated heart failure and cardiogenic shock, highlights its evolving role in contemporary cardiovascular medicine. This comprehensive review explores its pharmacodynamics, effects, and the challenges and opportunities it presents in various clinical settings. We describe levosimedan’s expanding usage, ranging from septic shock, intermittent intravenous in advanced heart failure, perioperative cardiac surgery and pulmonary hypertension management by inhaled levosimendan as well as its future prospects.

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Elbadawi

Elgendy

Saad

et al. 2018

The Annals of Thoracic Surgery

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Unlike conventional inotropes, levosimendan does not increase myocardial oxygen demand and its use in patients undergoing cardiac surgery raised great expectations. Results from a trial [1] have dampened the initial enthusiasm, however, showing no clinical benefit of prophylactic use of levosimendan. This lack of efficacy has also been confirmed in a meta-analysis by Elbadawi and colleagues [2], which nonetheless leaves considerable room for debate regarding the selection of studies included in their analysis.The main issue relates to timing of levosimendan infusion, which should be administered preoperatively to patients with severely reduced ventricular contractility. In order to ensure its prophylactic action, levosimendan should be administered at least 12 hours before cardiac surgery to pretreat the heart. In most studies, however, levosimendan infusion was started in the operating room and in many patients it was discontinued at the discretion of the treating physician [1]. Among the 2,273 patients included in the meta-analysis of Elbadawi and coworkers [2], levosimendan infusion was started 24 hours before operation in only 16 patients. In addition, levosimendan was administered to some patients with preserved ventricular function, making it unlikely that any further improvement of cardiac performance could be obtained. Despite such heterogeneity due to differences in the patients enrolled in the meta-analysis, the prophylactic use of levosimendan was associated with a significant reduction in acute kidney injury, suggesting improved renal perfusion with less need for conventional inotropic agents and/or vasopressors.According to our experience, in 100 coronary patients with severely depressed ventricular function, who underwent a complete revascularization strategy associated with mitral valve or ventricular restoration surgery when indicated, the use of levosimendan (low-dose infusion without bolus administered at least 12 hours before cardiac surgery without vasoconstrictors) may still have a role, but further studies evaluating the effects of "true" and "complete" prophylactic treatment with this inotropic agent are warranted.

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Is There Still Room for the Prophylactic Use of Levosimendan in Cardiac Surgery?

Cited by 5 publications

References 2 publications

Effect of Levosimendan Infusion 24 Hours Before CABG Surgery in Patients with Impaired Left Ventricular Function on the Need for Postoperative IABP

Effect of Levosimendan Infusion 24 Hours Before CABG Surgery in Patients with Impaired Left Ventricular Function on the Need for Postoperative IABP

Breaking Boundaries: Novel Effects of Levosimendan in Various Diseases

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