Effectiveness of prophylactic levosimendan in high-risk valve surgery patients.
OBJECTIVE
Levosimendan has anti-ischaemic effects, improves myocardial contractility and increases systemic, pulmonary and coronary vasodilatation. These properties suggest potential advantages in high-risk cardiac valve surgery patients where cardioprotection would be valuable. The present study investigated the peri-operative haemodynamic effects of prophylactic levosimendan infusion in cardiac valve surgery patients with low ejection fraction and/or severe pulmonary arterial hypertension.


METHODS
Between May 2006 and July 2007, 20 consecutive patients with severe pulmonary arterial hypertension (systolic pulmonary artery pressure ≥ 60 mmHg) and/or low ejection fraction (< 50%) who underwent valve surgery in our clinic were included in the study and randomised into two groups. Levosimendan was administered to 10 patients in group I and not to the 10 patients in the control group. Cardiac output (CO), cardiac index (CI), systemic vascular resistance (SVR), pulmonary vascular resistance (PVR) and mean pulmonary artery pressure (MPAP) were recorded for each patient preoperatively and for 24 hours following the operation.


RESULTS
CO and CI values were higher in the levosimendan group during the study period (p < 0.05). MPAP and PVR values were significantly lower in the levosimendan group for the 24-hour period (p < 0.05) and SVR values were significantly lower after 24 hours in both groups. When clinical results were considered, no difference in favour of levosimendan was detected regarding the mortality and morbidity rates between the groups.


CONCLUSIONS
Levosimendan improved the haemodynamics in cardiac valve surgery patients with low ejection fraction and/or severe pulmonary arterial hypertension, and facilitated weaning from cardiopulmonary bypass in such high-risk patients when started as a prophylactic agent.
Department of Cardiovascular Surgery, Turkey Yuksek Ihtisas Hospital, Ankara, Turkey.
Ozgur
O
Ersoy
Emre
E
Boysan
Ertekin Utku
EU
Unal
Kerem
K
Yay
Umit
U
Yener
Ferit
F
Cicekcioglu
Fehmi
F
Katircioglu
D062186:Arterial Pressure / Q000187:drug effects; D002315:Cardiopulmonary Bypass; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D065627:Familial Primary Pulmonary Hypertension; D006349:Heart Valve Diseases / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage*; D006976:Hypertension, Pulmonary / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D007263:Infusions, Parenteral; D011651:Pulmonary Artery / Q000187:drug effects* / Q000503:physiopathology; D011724:Pyridazines / Q000008:administration & dosage*; D012720:Severity of Illness Index; D000077464:Simendan; D013318:Stroke Volume / Q000187:drug effects; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey; D014655:Vascular Resistance / Q000187:drug effects
D002317:Cardiovascular Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan