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.
Hoefer
Daniel
D
Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria. daniel.hoefer@uibk.ac.at
Jonetzko
Patrycja
P
Hoermann
Christoph
C
Laufer
Guenther
G
Poelzl
Gerhard
G
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