title: A comparison of hemodynamic effects of levosimendan and dobutamine in patients undergoing mitral valve repair / replacement for severe mitral stenosis.
abstract: OBJECTIVE
  We aimed to compare the hemodynamic effects of levosimendan and dobutamine in patients undergoing mitral valve surgery on cardiopulmonary bypass (CPB).
  
  
  METHODS
  Sixty patients were divided into 2 groups of 30 each. Group-L patients received levosimendan 0.1 μg/kg/min and Group-D patients received dobutamine 5 μg/kg/min while weaning off CPB. Additional inotrope and/or vasoconstrictor were started based on hemodynamic parameters. Hemodynamic data were collected at the end and at 30 minutes after CPB, thereafter at 6, 12, 24, and 36 hours post-CPB. Mean arterial pressure (MAP), central venous pressure (CVP), heart rate (HR), cardiac index (CI), systemic vascular resistance index (SVRI), and lactate levels were measured.
  
  
  RESULTS
  Group-L showed increased requirement of inotropes and vasoconstrictors. The SVRI, CVP, and MAP were reduced more in Group-L. The CI was low in Group-L in the initial period when compared to Group-D. Later Group-L patients showed a statistically significant increase in CI even after 12 hrs of discontinuation of levosimendan infusion. The HR was increased more in Group-D. Lactate levels, intensive care unit stay, and duration of ventilation were similar in both groups.
  
  
  CONCLUSIONS
  Levosimendan 0.1 μg/kg/min compared to dobutamine 5 μg/kg/min showed more vasodilation and lesser inotropic activity in patients undergoing mitral valve surgery for mitral stenosis. Levosimendan compared to dobutamine showed a statistically significant increase in CI even after 12 hrs of discontinuation. The requirement of another inotrope or vasopressor was frequent in levosimendan group.
authors.affiliation: Department of Cardiac Anesthesiology, Sri Ramachandra Medical College, Chennai, Tamil Nadu, India.
authors.forename: Ravikumar
authors.initials: R
authors.lastname: Gandham
authors.forename: Ayya
authors.initials: A
authors.lastname: Syamasundar
authors.forename: Harish
authors.initials: H
authors.lastname: Ravulapalli
authors.forename: Ranjith B
authors.initials: RB
authors.lastname: Karthekeyan
authors.forename: Mahesh
authors.initials: M
authors.lastname: Vakamudi
authors.forename: Rajeshkumar
authors.initials: R
authors.lastname: Kodalli
authors.forename: Sushma
authors.initials: S
authors.lastname: Nandipati
mesh_terms: D000328:Adult; D062186:Arterial Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D002315:Cardiopulmonary Bypass; D002316:Cardiotonic Agents / Q000494:pharmacology*; D002496:Central Venous Pressure / Q000187:drug effects; D004280:Dobutamine / Q000494:pharmacology*; D004311:Double-Blind Method; D005260:Female; D006324:Heart Arrest, Induced; D006339:Heart Rate / Q000187:drug effects; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006835:Hydrazones / Q000494:pharmacology*; D007036:Hypothermia, Induced; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000601:surgery*; D011446:Prospective Studies; D011724:Pyridazines / Q000494:pharmacology*; D000077464:Simendan; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000187:drug effects
chemical_list: D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D019344:Lactic Acid; D000077464:Simendan; D004280:Dobutamine