Preservation of renal function in cardiac surgery patients with low cardiac output syndrome: levosimendan vs beta agonists

Abstract

BackgroundSome studies have been performed to assess the effects of levosimendan on cardiac function when administered to cardiac surgery patients with low cardiac output syndrome (LCOS) in the immediate postoperative period. Levosimendan is an inotropic agent for the treatment of low cardiac output syndrome that seems to have a protective effect on renal function.MethodsIt is a quasi-experimental study. A total of 100 patients with LCOS received either beta-agonists or levosimendan. We assessed the incidence of postoperative kidney failure in cardiac surgery patients. In patients who had kidney failure at diagnosis of LCOS, we examined whether differences existed in the evolution of kidney failure based on the treatment administered for LCOS. The parameters measured included haemodynamics, oxygen supply, and renal function as assessed by the AKI scale. ANOVA, Student’s t-test and Wilcoxon or Friedman tests were used.ResultsUp to 30% of cardiac surgery patients had kidney failure at diagnosis of LCOS. Kidney failure at discharge from the ICU was more frequent in patients who received beta-agonist drugs as compared to those who received levosimendan (p < 0.05).ConclusionThe incidence of kidney failure decreased with the postoperative administration of levosimendan to cardiac surgery patients with LCOS, as compared to beta-agonists.Trial registrationCurrent Controlled Trials ISRCTN 46058317. Date of registration: 7/10/2019.Retrospectively registered.

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

“…In our study, the results also demonstrated that the incidence of renal insufficiency was significantly lower in the levosimendan group, which was consistent with the results of many studies that showed levosimendan can improve kidney function in cardiac surgery. Guerrero Orriach et al [ 26 ] demonstrated that the incidence of kidney failure was lower with the postoperative administration of levosimendan than with the administration of beta-agonists in patients undergoing cardiac surgery with LCOS. However, some studies have drawn different conclusions.…”

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

“…These aggregated findings are amplified by observations in a series of recent trials. Guerrero Orriach et al [ 79 ] have conducted a 3-year study in cardiac surgery patients with LCOS. A total of 100 adult patients meeting pre-specified criteria for LCOS requiring inotropic support were recruited, of whom 50 received levosimendan (0.1 μg/kg/min/24 h to a target dose of 12.5 mg) and 50 received unspecified beta-agonist inotropes at undisclosed dosages.…”

“…*Statistically significant difference. Figure drawn freely from the data reported by Guerrero-Orriach et al [ 79 ] …”

Renal and Neurologic Benefit of Levosimendan vs Dobutamine in Patients With Low Cardiac Output Syndrome After Cardiac Surgery: Clinical Trial FIM-BGC-2014-01

“…Cardiovascular response to levosimendan vs beta-agonists (such as dobutamine) in the treatment of LCOS has been assessed in a variety of studies ( Follath et al., 2002 ; Alvarez et al., 2013 ; Gandham et al., 2013 ; Xuan et al., 2013 ). The scientific literature demonstrates that levosimendan improves renal function, increases survival rates, and causes fewer side effects ( Yilmaz et al., 2007 ; Bragadottir et al., 2013 ; Yilmaz et al., 2013 ; Baysal et al., 2014 ; CHEETAH Study Group, 2018 ; Guerrero Orriach et al., 2019 ). Some studies suggest that the organ-protective effects of levosimendan are mediated by its action on potassium channels and mitochondria ( Kopustinskiene et al., 2004 ; Du Toit et al., 2008 ; Soeding et al., 2011 ).…”