Successful administration of levosimendan in a patient with low-gradient low-output aortic stenosis.
Aortic valve replacement in patients suffering from low-gradient aortic stenosis and congestive heart failure is associated with high operative mortality, and the perioperative use of inotropes is common. Levosimendan is a calcium sensitizer with positive inotropic and vasodilatory effects and has been developed for treatment of decompensated heart failure. Although its use in patients with low-gradient aortic stenosis is not established, we hypothesized that it might have beneficial effects on outcome after aortic valve replacement. We report on a high-risk operation in a 73-year-old man with low-gradient aortic stenosis, congestive heart failure and coronary artery disease. Levosimendan was administered perioperatively (0.1 mg/kg/min 16 hours prior to the operation without a loading dose) and allowed rapid recovery of the patient, who required only brief treatment in the intensive care unit. No levosimendan-specific adverse events were observed, in particular no hypotension. The excellent postoperative result was maintained after the patient was discharged from hospital.
Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria. daniel.hoefer@uibk.ac.at
Daniel
D
Hoefer
Patrycja
P
Jonetzko
Christoph
C
Hoermann
Guenther
G
Laufer
Gerhard
G
Poelzl
D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage*; D008297:Male; D019990:Perioperative Care / Q000379:methods*; D011724:Pyridazines / Q000008:administration & dosage*; D012720:Severity of Illness Index; D000077464:Simendan; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000517:prevention & control*
D006835:Hydrazones; D011724:Pyridazines; D014665:Vasodilator Agents; D000077464:Simendan