Levosimendan may improve survival in patients requiring mechanical assist devices for post-cardiotomy heart failure.
BACKGROUND
Most case series suggest that less than half of the patients receiving a mechanical cardiac assist device as a bridge to recovery due to severe post-cardiotomy heart failure survive to hospital discharge. Levosimendan is the only inotropic substance known to improve medium term survival in patients suffering from severe heart failure.


METHODS
This retrospective analysis covers our single centre experience. Between July 2000 and December 2004, 41 consecutive patients were treated for this complication. Of these, 38 patients are included in this retrospective analysis as 3 patients died in the operating room. Levosimendan was added to the treatment protocol for the last nine patients.


RESULTS
Of 29 patients treated without levosimendan, 20 could be weaned off the device, 9 survived to intensive care unit discharge, 7 left hospital alive and 3 survived 180 days. All 9 patients treated with levosimendan could be weaned, 8 were discharged alive from ICU and hospital, and 7 lived 180 days after surgery (p < 0.002 for 180 day survival). Plasma lactate after explantation of the device was significantly lower (p = 0.002), as were epinephrine doses. Time spent on renal replacement therapy was significantly shorter (p = 0.023).


CONCLUSIONS
Levosimendan seems to improve medium term survival in patients failing to wean off cardiopulmonary bypass and requiring cardiac assist devices as a bridge to recovery. This retrospective analysis justifies prospective randomised investigations of levosimendan in this group of patients.
Braun
Jan-Peter
JP
Department of Anesthesiology and Intensive Care, Campus Charité Mitte, Charité University Hospital, Charité-University Medicine Berlin, Germany. jan.braun@charite.de
Jasulaitis
Dominik
D
Moshirzadeh
Maryam
M
Doepfmer
Ulrich R
UR
Kastrup
Marc
M
von Heymann
Christian
C
Dohmen
Pascal M
PM
Konertz
Wolfgang
W
Spies
Claudia
C
D000368:Aged; D002303:Cardiac Output, Low / Q000188:drug therapy* / Q000401:mortality; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy* / Q000401:mortality; D011724:Pyridazines / Q000627:therapeutic use*; D012189:Retrospective Studies; D000077464:Simendan; D015996:Survival Rate; D014665:Vasodilator Agents / Q000627:therapeutic use*
D006835:Hydrazones; D011724:Pyridazines; D014665:Vasodilator Agents; D000077464:Simendan