Influence of levosimendan on organ dysfunction in patients with severely reduced left ventricular function undergoing cardiac surgery.

Abstract

OBJECTIVES:

Levosimendan is an inotropic drug with organ-protective properties due to its activation of mitochondrial K(ATP) channels. This prospective, randomized, double-blind, placebo-controlled study investigated whether administration of levosimendan prior to cardiopulmonary bypass could reduce organ dysfunction and influence subsequent secondary endpoints.

PATIENTS AND METHODS:

Patients with left ventricular ejection fraction <30% scheduled for elective coronary artery bypass surgery (with or without valve surgery) received either levosimendan (12.5 mg, 0.1 µg kg(-1) per min; n = 17) or placebo (n = 16) central venous infusion, immediately after anaesthesia induction, as add-on medication to a goal-orientated treatment algorithm.

RESULTS:

A total of 33 patients completed the study. There were no statistically significant differences in Sequential Organ Failure Assessment scores, survival, haemodynamic parameters, time to extubation, time in intensive care unit, need for haemodialysis or health-related quality-of-life at 6 months post operation. The levosimendan group compared with the placebo group had significantly lower use of epinephrine (35% versus 81%) and nitroglycerine (6% versus 44%) 24 h postoperation, and significantly less frequent serious adverse events (13% versus 47%).

CONCLUSIONS:

These preliminary results show that timely perioperative levosimendan treatment is feasible, has a favourable safety profile safe and may help to prevent low cardiac output syndrome. However, organ function was not preserved. Further studies, using larger sample sizes, are required.

• Authors: Joachim Erb, Torsten Beutlhauser, Aarne Feldheiser, Birgit Schuster, Sascha Treskatsch, Herko Grubitzsch, Claudia Spies
• Journal: The Journal of international medical research (J Int Med Res) Vol. 42 Issue 3 Pg. 750-64 (Jun 2014) ISSN: 1473-2300 [Electronic] England
• PMID: 24781725 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Chemical References

• Cardiotonic Agents
• Hydrazones
• Pyridazines
• Vasoconstrictor Agents
• Simendan
• Enoximone
• Norepinephrine

Topics

• Aged
• Aged, 80 and over
• Blood Pressure (drug effects)
• Cardiomyopathies (drug therapy, pathology, surgery)
• Cardiotonic Agents (therapeutic use)
• Coronary Artery Bypass
• Double-Blind Method
• Enoximone (therapeutic use)
• Female
• Humans
• Hydrazones (therapeutic use)
• Infusions, Intravenous
• Male
• Middle Aged
• Myocardial Ischemia (drug therapy, pathology, surgery)
• Norepinephrine (therapeutic use)
• Prospective Studies
• Pyridazines (therapeutic use)
• Simendan
• Stroke Volume (drug effects)
• Treatment Outcome
• Vasoconstrictor Agents (therapeutic use)
• Ventricular Dysfunction, Left (drug therapy, pathology, surgery)