Optimization with levosimendan improves outcomes after left ventricular assist device implantation

Abstract

OBJECTIVES The aim of this study was to examine the haemodynamic effects of preoperative levosimendan infusion in patients who underwent left ventricular assist device implantation and evaluate the prognoses. METHODS Between May 2013 and October 2018, 85 adult patients who underwent left ventricular assist device implantation were included; 44 and 41 patients suffered from dilated cardiomyopathy and ischaemic cardiomyopathy, respectively. Patients were divided into 2 groups: group A (58 patients) included those who received levosimendan infusion in addition to other inotropes and group B (27 patients) included those who received inotropic agents other than levosimendan. Levosimendan infusion was started at a dose of 0.1 µg⋅kg−1⋅min−1 for a maximum of 48 h without a bolus. The primary outcome was early right ventricular failure (RVF). The secondary outcomes were in-hospital mortality, need for right ventricular assist device, late RVF and recovery of end-organ functions. The safety end points of levosimendan included hypotension, atrial fibrillation, ventricular tachycardia or fibrillation and resuscitated cardiac arrest. RESULTS Patient characteristics were similar in both groups. No significant differences between groups were observed in the rates of early mortality, RVF, need for right ventricular assist device, cardiopulmonary bypass time and intensive care unit stay. Survival rates at 30 days, 1 year and 3 years and freedom from late RVF were similar between the groups. Administration of levosimendan was safe, generally well-tolerated and not interrupted because of side effects. CONCLUSIONS Levosimendan therapy was well-tolerated in patients who received permanent left ventricular assist devices. Combined preoperative therapy with inotropes and levosimendan significantly improves end-organ functions.

Levosimendan in intensive care and emergency medicine: literature update and expert recommendations for optimal efficacy and safety

“…Matching the appropriate type of patient to the appropriately timed, appropriately dosed intervention remains a challenge for the design of adequately powered, informative clinical trials. The observations of Kocabeyoglu et al [ 25 ] on the postoperative optimization of left ventricular assist device implantation by levosimendan is a further example of interesting potential applications that merit exploration, but which might be difficult to substantiate without very close monitoring of multiple potential confounding influences.…”

Evidence and Current Use of Levosimendan in the Treatment of Heart Failure: Filling the Gap

“…Furthermore, it has been shown in preliminary studies 78 that levosimendan infusion 24–48 hours before LVAD implantation can improve short- and long-term outcomes. Despite Kocabeyoglu et al, 79 failed to confirm a reduction in early right ventricular failure and mortality rates in the post-operative LVAD setting, the authors claimed levosimendan as a preferable alternative to conventional adrenergic inotropes in these patients due to its hemodynamic effects of reduction in pulmonary arterial pressure and improvement in right ventricular function.…”

Levosimendan Efficacy and Safety: 20 years of SIMDAX in Clinical Use

“…In addition to its use in maintaining haemodynamic stability in patients with AdHF, preoperative use of IV levosimendan in patients undergoing implantation of an LVAD, or identification of LVAD candidates, has been reported to be “generally well-tolerated and not interrupted because of side effects” and associated with significant improvements in end-organ function, although with similar early mortality rates. [ 147 ] This is an application where a substantial expansion in the use of levosimendan may be anticipated.…”