Levosimendan Reduces Cardiac Troponin Release After Cardiac Surgery: A Meta-analysis of Randomized Controlled Studies

Zangrillo, Alberto; Biondi‐Zoccai, Giuseppe; Mizzi, Anna; Bruno, G; Bignami, Elena; Gerli, Chiara; Santis, Vincenzo De; Tritapepe, Luigi; Landoni, Giovanni

doi:10.1053/j.jvca.2008.11.013

Cited by 63 publications

(33 citation statements)

References 31 publications

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“…The long-term hemodynamic responses [10] following the administration of short-lasting levosimendan [13, 30] relate to the combination of differences in elimination half-life [11, 20], and plasma protein binding [12, 20] of levosimendan and OR-1896 [17, 24–27]. In fact, in addition to a calcium-sensitizing effect similar to that of levosimendan, OR-1896 exerts a potent vasodilatory effect on isolated coronary and skeletal muscle arteries in the rat [6].…”

Section: Discussionmentioning

confidence: 99%

Levosimendan and its metabolite OR-1896 elicit KATP channel-dependent dilation in resistance arteries in vivo

Gődény

Pollesello

Édes

et al. 2013

Pharmacological Reports

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Background Levosimendan and its long-lived metabolite OR-1896 produce vasodilation in different types of vessels by activating ATP-sensitive (KATP) and other potassium channels. Methods In the present study we applied intravital videomicroscopy to investigate the in situ effects of levosimendan and OR-1896 on the diameters of real resistance arterioles (rat cremaster muscle arterioles with diameters of ~ 20 μm). Results Levosimendan and OR-1896 induced concentration-dependent (1 nM – 100 μM) dilations to similar extents in these arterioles (maximal dilation from 23 ± 2 to 33 ± 2 μm and from 22 ± 1 to 32 ± 1 μm, respectively). The arteriolar dilations induced by the selective KATP channel opener pinacidil (1 nM – 10 μM) (maximal dilation from 22 ± 4 μm to 35 ± 3 μm) were diminished in the presence of the selective KATP channel blocker – glibenclamide (5 μM) (maximal diameter attained: 22 ± 1 μm). Glibenclamide also counteracted the maximal dilations in response to levosimendan or OR-1896 (to 23 ± 3 μm or 22 ± 5 μm, respectively). Conclusions In conclusion, this is the first demonstration that levosimendan and OR-1896 elicit arteriolar dilation in vivo, via activation of KATP channels in real resistance vessels in the rat.

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Section: Discussionmentioning

confidence: 99%

Levosimendan and its metabolite OR-1896 elicit KATP channel-dependent dilation in resistance arteries in vivo

Gődény

Pollesello

Édes

et al. 2013

Pharmacological Reports

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“…184,185,202---204,216,217 Levosimendan has been shown to have a preconditioning effect even at very low doses. Tritapepe 143,144 and Zangrillo 218 administration of a 24 g/kg bolus over 10 min reduces postoperative serum troponin levels. Although this system could be considered effective, it evidently does not improve contractility.…”

Section: Levosimendan and Conditioningmentioning

confidence: 97%

Clinical Practice Guideline (CPG). Recommendations on strategy for reducing risk of heart failure patients requiring noncardiac surgery

Escudero¹,

Vecino²,

Baluja³

et al. 2015

Revista Española de Anestesiología y Reanimación (English Editi

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“…Levosimendan improves cardiac performance in myocardial stunning after percutaneous intervention [40]. The latest meta-analysis, including 139 patients from 5 randomized controlled studies, showed that levosimendan reduces postoperative cardiac troponin release irrespective of cardiopulmonary bypass (CPB; Figure 3) [41]. Tritapepe and colleagues [12] showed that levosimendan pre-treatment improved outcome in 106 patients undergoing CABG.…”

Section: Risk Modulation: Cardioprotective Agentsmentioning

confidence: 99%

Clinical review: Practical recommendations on the management of perioperative heart failure in cardiac surgery

et al. 2010

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Acute cardiovascular dysfunction occurs perioperatively in more than 20% of cardiosurgical patients, yet current acute heart failure (HF) classification is not applicable to this period. Indicators of major perioperative risk include unstable coronary syndromes, decompensated HF, significant arrhythmias and valvular disease. Clinical risk factors include history of heart disease, compensated HF, cerebrovascular disease, presence of diabetes mellitus, renal insufficiency and high-risk surgery. EuroSCORE reliably predicts perioperative cardiovascular alteration in patients aged less than 80 years. Preoperative B-type natriuretic peptide level is an additional risk stratification factor. Aggressively preserving heart function during cardiosurgery is a major goal. Volatile anaesthetics and levosimendan seem to be promising cardioprotective agents, but large trials are still needed to assess the best cardioprotective agent(s) and optimal protocol(s). The aim of monitoring is early detection and assessment of mechanisms of perioperative cardiovascular dysfunction. Ideally, volume status should be assessed by 'dynamic' measurement of haemodynamic parameters. Assess heart function first by echocardiography, then using a pulmonary artery catheter (especially in right heart dysfunction). If volaemia and heart function are in the normal range, cardiovascular dysfunction is very likely related to vascular dysfunction. In treating myocardial dysfunction, consider the following options, either alone or in combination: low-to-moderate doses of dobutamine and epinephrine, milrinone or levosimendan. In vasoplegia-induced hypotension, use norepinephrine to maintain adequate perfusion pressure. Exclude hypovolaemia in patients under vasopressors, through repeated volume assessments. Optimal perioperative use of inotropes/vasopressors in cardiosurgery remains controversial, and further large multinational studies are needed. Cardiosurgical perioperative classification of cardiac impairment should be based on time of occurrence (precardiotomy, failure to wean, postcardiotomy) and haemodynamic severity of the patient's condition (crash and burn, deteriorating fast, stable but inotrope dependent). In heart dysfunction with suspected coronary hypoperfusion, an intra-aortic balloon pump is highly recommended. A ventricular assist device should be considered before end organ dysfunction becomes evident. Extra-corporeal membrane oxygenation is an elegant solution as a bridge to recovery and/or decision making. This paper offers practical recommendations for management of perioperative HF in cardiosurgery based on European experts' opinion. It also emphasizes the need for large surveys and studies to assess the optimal way to manage perioperative HF in cardiac surgery.

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Levosimendan Reduces Cardiac Troponin Release After Cardiac Surgery: A Meta-analysis of Randomized Controlled Studies

Cited by 63 publications

References 31 publications

Levosimendan and its metabolite OR-1896 elicit KATP channel-dependent dilation in resistance arteries in vivo

Levosimendan and its metabolite OR-1896 elicit KATP channel-dependent dilation in resistance arteries in vivo

Clinical Practice Guideline (CPG). Recommendations on strategy for reducing risk of heart failure patients requiring noncardiac surgery

Clinical review: Practical recommendations on the management of perioperative heart failure in cardiac surgery

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