Preoperative and perioperative use of levosimendan in cardiac surgery: European expert opinion.
In cardiac surgery, postoperative low cardiac output has been shown to correlate with increased rates of organ failure and mortality. Catecholamines have been the standard therapy for many years, although they carry substantial risk for adverse cardiac and systemic effects, and have been reported to be associated with increased mortality. On the other hand, the calcium sensitiser and potassium channel opener levosimendan has been shown to improve cardiac function with no imbalance in oxygen consumption, and to have protective effects in other organs. Numerous clinical trials have indicated favourable cardiac and non-cardiac effects of preoperative and perioperative administration of levosimendan. A panel of 27 experts from 18 countries has now reviewed the literature on the use of levosimendan in on-pump and off-pump coronary artery bypass grafting and in heart valve surgery. This panel discussed the published evidence in these various settings, and agreed to vote on a set of questions related to the cardioprotective effects of levosimendan when administered preoperatively, with the purpose of reaching a consensus on which patients could benefit from the preoperative use of levosimendan and in which kind of procedures, and at which doses and timing should levosimendan be administered. Here, we present a systematic review of the literature to report on the completed and ongoing studies on levosimendan, including the newly commenced LEVO-CTS phase III study (NCT02025621), and on the consensus reached on the recommendations proposed for the use of preoperative levosimendan.
Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Graz, Graz, Austria. Electronic address: wolfgang.toller@medunigraz.at.
W
W
Toller
Department of Anaesthesiology, University of Lübeck, Lübeck, Germany.
M
M
Heringlake
Department of Anaesthesia and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
F
F
Guarracino
Department of Cardiothoracic Surgery, Skånes University Hospital Lund, Lund, Sweden.
L
L
Algotsson
Department of Anaesthesiology and Intensive Care, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
J
J
Alvarez
Department of Anaesthesiology and Intensive Care Unit, Aristotle University of Thessaloniki, AHEPA Teaching Hospital, Thessaloniki, Greece.
H
H
Argyriadou
Heart Failure Unit, Rabin Medical Centre, Petach Tikva, Israel.
T
T
Ben-Gal
Department of Anaesthesiology and Intensive Care, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
V
V
Černý
Department of Anaesthesiology and Intensive Care, Hôpital Européen Georges Pompidou, AP-HP, Paris, France; Université Paris Descartes, Paris, France.
B
B
Cholley
"B. V. Petrovsky" Russian National Centre of Surgery, Moscow, Russia.
A
A
Eremenko
Department of Cardio-Anaesthesiology, University Hospital Virgen de la Victoria de Malaga, Malaga, Spain.
J L
JL
Guerrero-Orriach
Heart Centre and Intensive Care Unit, Tampere University Hospital, Tampere, Finland.
K
K
Järvelä
Department of Anaesthesiology and Intensive Care, University Hospital Split, Split, Croatia.
N
N
Karanovic
Orion Pharma, Critical Care, Espoo, Finland.
M
M
Kivikko
Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland.
P
P
Lahtinen
"E. N. Meshalkin" State Novosibirsk Research Institute of Circulation Pathology, Novosibirsk, Russia.
V
V
Lomivorotov
Department of Internal Medicine and Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA.
R H
RH
Mehta
Department of Cardio-Anaesthesiology, University Clinical Centre Ljubljana, Ljubljana, Slovenia.
Š
Š
Mušič
Orion Pharma, Critical Care, Espoo, Finland.
P
P
Pollesello
Department of Anaesthesiology, UZ Leuven, Campus Gasthuisberg, Leuven, Belgium.
S
S
Rex
Cardiothoracic Anaesthesiology and Intensive Care, Department of Anaesthesiology and Intensive Care Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
H
H
Riha
Institute of Anaesthesiology, University Hospital of Zürich, Zürich, Switzerland.
A
A
Rudiger
Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Helsinki University Hospital, Helsinki, Finland.
M
M
Salmenperä
Department of Anaesthesiology and Intensive Care, Gottsegen György National Institute of Cardiology, Budapest, Hungary.
L
L
Szudi
Department of Anaesthesiology and Intensive Care, Policlinico "Umberto I", "La Sapienza" University of Rome, Rome, Italy.
L
L
Tritapepe
Department of Critical Care, St. Thomas' Hospital, London, UK.
D
D
Wyncoll
Department of Cardiothoracic Surgery, Karolinska University Hospital Solna, Stockholm, Sweden.
A
A
Öwall
D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery; D002986:Clinical Trials as Topic / Q000379:methods; D005060:Europe / Q000453:epidemiology; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D019990:Perioperative Care / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D011724:Pyridazines / Q000627:therapeutic use*; D000077464:Simendan
D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan
CABG; Cardiac surgery; Cardioprotective; Inodilator; Low cardiac output syndrome; Valve surgery