Levosimendan Use Increases Cardiac Performance after Coronary Artery Bypass Grafting in End-Stage Renal Disease Patients

Atalay, Hakan; Temizturk, Zeki; Altınsoy, Hasan Baki; Azboy, Davut; Çolak, Salih; Atalay, Atakan; Dogan, Omer Faruk

doi:10.1532/hsf.1426

Cited by 10 publications

(4 citation statements)

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“…A recent study using the Chang Gung Research Database from Taiwan on 52 patients with eGFR < 30 ml/min/1.73 m 2 receiving levosimendan showed similar outcomes compared to 374 patients receiving dobutamine ( 13 ). Similar results are reported from 25 patients with end-stage renal disease undergoing coronary artery bypass grafting who received levosimendan showing similar side effects compared to 33 patients on placebo ( 34 ). To the best of our knowledge no other study has shown an increase in side effects of levosimendan when used in eGFR < 30 ml/min/1.73 m 2 either.…”

Section: Discussionsupporting

confidence: 78%

Levosimendan in acute heart failure with severely reduced kidney function, a propensity score matched registry study

Rottmann

Breiden²,

Bemtgen³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundPatients with heart failure frequently present with kidney dysfunction. Kidney function is relevant, as prognosis declines with reduced kidney function and potentially beneficial drugs like levosimendan are contraindicated for missing safety data.Materials and methodsA single-center retrospective registry study was conducted including all patients receiving levosimendan on a medical intensive care unit between January 2010 and December 2019. Exclusion criteria were a follow-up less than 24 h or missing glomerular filtration rate (eGFR) before administration of levosimendan. The first course of treatment was evaluated. Patients were stratified by eGFR before drug administration and the primary endpoint was a composite of supraventricular-, ventricular tachycardia and death within 7 days after administration of levosimendan. An internal control group was created by propensity score matching.ResultsA total of 794 patients receiving levosimendan were screened and 368 unique patients were included. Patients were predominantly male (73.6%) and median age was 63 years. Patients were divided by eGFR into three groups: >60 ml/min/1.73 m2 (n = 110), 60–30 ml/min/1.73 m2 (n = 130), and <30 ml/min/1.73 m2 (n = 128). ICU survival was significantly lower in patients with lower eGFR (69.1, 57.7, and 50.8%, respectively, p = 0.016) and patients with lower eGFR were significantly older and had significantly more comorbidities. The primary combined endpoint was reached in 61.8, 63.1, and 69.5% of subjects, respectively (p = 0.396). A multivariate logistic regression model suggested only age (p < 0.020), extracorporeal membrane oxygenation (p < 0.001) or renal replacement therapy (p = 0.028) during day 1–7 independently predict the primary endpoint while kidney function did not (p = 0.835). A propensity score matching of patients with eGFR < 30 and >30 ml/min/1.73 m2 based on these predictors of outcome confirmed the primary endpoint (p = 0.886).ConclusionThe combined endpoint of supraventricular-, ventricular tachycardia and death within 7 days was reached at a similar rate in patients independently of kidney function. Prospective randomized trials are warranted to clarify if levosimendan can be used safely in severely reduced kidney function.

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Section: Discussionsupporting

confidence: 78%

Levosimendan in acute heart failure with severely reduced kidney function, a propensity score matched registry study

Rottmann

Breiden²,

Bemtgen³

et al. 2022

Front. Cardiovasc. Med.

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“…The mechanism of action of levosimendan also includes the activation of adenosine triphosphate-sensitive potassium channels, which results in improved myocardial contractility, vasodilation, and cardioprotection. Results of recent clinical trials have shown that the administration of the calcium sensitizer levosimendan after cardiac surgery can improve cardiac and renal functions of patients [ 12 – 14 ]. However, these benefits were greatest for the cardiac surgery patients with severe valvular disease or patients with severe coronary heart disease with diminished LVEF.…”

Section: Discussionmentioning

confidence: 99%

Prospective Study on the Postoperative Use of Levosimendan After Conventional Heart Valve Replacement

et al. 2021

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Background The aim of this study was to explore the effect of levosimendan in patients after heart valve replacement and its influence on postoperative recovery. Material/Methods This prospective study included 185 patients with valvular diseases undergoing conventional valve replacement. Patients were divided into 2 groups using a random number table before surgery. Patients in the levosimendan group were administrated levosimendan intravenous infusion immediately after entering the Intensive Care Unit (ICU). The left ventricular ejection fraction (LVEF), cardiac output, and heart failure-related index, such as B-type natriuretic peptide (BNP) level, were recorded at 1, 3, and 7 days after surgery. The dosage and administration time of dopamine and epinephrine, mechanical ventilation time, ICU length of stay, and postoperative adverse events were recorded. Results Cardiac output and LVEF of patients in the levosimendan group were significantly higher than those in the control group at different time points ( P <0.05), and BNP level was lower than that of the control group ( P <0.0001). Dosage and administration time of dopamine and epinephrine in the levosimendan group were lower than those of the control group ( P <0.0001, P <0.0001, respectively). ICU length of stay and total incidence of postoperative adverse events were lower than those of the control group ( P <0.0001, P =0.002, respectively). Conclusions Levosimendan administration immediately after heart valve replacement effectively improved the heart function of patients, reduced administration of vasoactive drugs, shortened length of ICU stay, reduced incidence of postoperative adverse events, and promoted recovery of patients after surgery.

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“…The use of IABP may have had an additional positive effect on coronary perfusion, and hence cardiac performance. Similarly, the RCTs of Anastasiadis 25 and Atalay 26 observed increases in cardiac index 24 hours and 7 days after cardiac surgery. Both studies, however, included only patients with mild or moderate left ventricular dysfunction undergoing CABG.…”

Section: Discussionmentioning

confidence: 82%

Levosimendan and systemic vascular resistance in cardiac surgery patients: a systematic review and meta-analysis

Terbeck

Heinisch

Lenz

et al. 2019

Sci Rep

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Levosimendan is a potent non-adrenergic inodilator agent. The net effect of hemodynamic changes may result in a hyperdynamic state with low systemic vascular resistance. We conducted a systematic review and meta-analysis assessing hemodynamics in cardiac surgery patients treated with levosimendan. English-language literature was searched systematically from 2006 until October 2018, including randomized controlled trials and case-matched or retrospective studies providing at least two sequentially measured hemodynamic variables in adult patients who underwent cardiac surgery with cardiopulmonary bypass and were treated with levosimendan in comparison to alternative drugs or devices. Cardiac index significantly increased in the levosimendan group by 0.74 (0.24 to 1.23) [standardized mean difference (95% CI); p = 0.003] from baseline to postoperative day (POD) 1, and by 0.75 (0.25 to 1.25; p = 0.003) from baseline to POD 7, when corrected for the standardized mean difference at baseline by a multivariate mixed effects meta-analysis model. With this correction for baseline differences, other hemodynamic variables including systemic vascular resistance did not significantly differ until POD 1 [−0.17 (−0.64 to 0.30), p = 0.48] and POD 7 [−0.13 (−0.61 to 0.34), p = 0.58] between the levosimendan and the comparator group. Levosimendan increases cardiac index in patients undergoing cardiac surgery. Although levosimendan has inodilator properties, this meta-analysis finds no clinical evidence that levosimendan produces vasopressor-resistant vasoplegic syndrome.

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Levosimendan Use Increases Cardiac Performance after Coronary Artery Bypass Grafting in End-Stage Renal Disease Patients

Cited by 10 publications

References 0 publications

Levosimendan in acute heart failure with severely reduced kidney function, a propensity score matched registry study

Levosimendan in acute heart failure with severely reduced kidney function, a propensity score matched registry study

Prospective Study on the Postoperative Use of Levosimendan After Conventional Heart Valve Replacement

Levosimendan and systemic vascular resistance in cardiac surgery patients: a systematic review and meta-analysis

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