title: Cardiac, renal, and neurological benefits of preoperative levosimendan administration in patients with right ventricular dysfunction and pulmonary hypertension undergoing cardiac surgery: evaluation with two biomarkers neutrophil gelatinase-associated lipocalin and neuronal enolase.
abstract: OBJECTIVE
  To evaluate if the preoperative administration of levosimendan in patients with right ventricular (RV) dysfunction, pulmonary hypertension, and high perioperative risk would improve cardiac function and would also have a protective effect on renal and neurological functions, assessed using two biomarkers neutrophil gelatinase-associated lipocalin (N-GAL) and neuronal enolase.
  
  
  METHODS
  This is an observational study. Twenty-seven high-risk cardiac patients with RV dysfunction and pulmonary hypertension, scheduled for cardiac valve surgery, were prospectively followed after preoperative administration of levosimendan. Levosimendan was administered preoperatively on the day before surgery. All patients were considered high risk of cardiac and perioperative renal complications. Cardiac function was assessed by echocardiography, renal function by urinary N-GAL levels, and the acute kidney injury scale. Neuronal damage was assessed by neuron-specific enolase levels.
  
  
  RESULTS
  After surgery, no significant variations were found in mean and SE levels of N-GAL (14.31 [28.34] ng/mL vs 13.41 [38.24] ng/mL), neuron-specific enolase (5.40 [0.41] ng/mL vs 4.32 [0.61] ng/mL), or mean ± SD creatinine (1.06±0.24 mg/dL vs 1.25±0.37 mg/dL at 48 hours). RV dilatation decreased from 4.23±0.7 mm to 3.45±0.6 mm and pulmonary artery pressure from 58±18 mmHg to 42±19 mmHg at 48 hours.
  
  
  CONCLUSIONS
  Preoperative administration of levosimendan has shown a protective role against cardiac, renal, and neurological damage in patients with a high risk of multiple organ dysfunctions undergoing cardiac surgery.
authors.affiliation: Department of Cardio-Anaesthesiology, University Hospital Virgen de la Victoria, Málaga, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Guerrero-Orriach
authors.affiliation: Department of Cardio-Anaesthesiology, University Hospital Virgen de la Victoria, Málaga, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ariza-Villanueva
authors.affiliation: Department of Cardio-Anaesthesiology, University Hospital Virgen de la Victoria, Málaga, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Florez-Vela
authors.affiliation: CIBER Fisiología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Málaga, Spain; Department of Nutrition and Endocrinology, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), University Hospital Virgen de la Victoria, Málaga, Spain.
authors.forename: Lourdes
authors.initials: L
authors.lastname: Garrido-Sánchez
authors.affiliation: Department of Cardio-Anaesthesiology, University Hospital Virgen de la Victoria, Málaga, Spain.
authors.forename: María Isabel
authors.initials: MI
authors.lastname: Moreno-Cortés
authors.affiliation: Department of Cardio-Anaesthesiology, University Hospital Virgen de la Victoria, Málaga, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Galán-Ortega
authors.affiliation: Department of Cardio-Anaesthesiology, University Hospital Virgen de la Victoria, Málaga, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Ramírez-Fernández
authors.affiliation: Department of Nutrition and Endocrinology, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), University Hospital Virgen de la Victoria, Málaga, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Alcaide Torres
authors.affiliation: Department of Nutrition and Endocrinology, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), University Hospital Virgen de la Victoria, Málaga, Spain.
authors.forename: Concepción Santiago
authors.initials: CS
authors.lastname: Fernandez
authors.affiliation: Department of Cardio-Anaesthesiology, University Hospital Virgen de la Victoria, Málaga, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Navarro Arce
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Virgen de la Victoria, Málaga, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: Melero-Tejedor
authors.affiliation: Department of Cardio-Anaesthesiology, University Hospital Virgen de la Victoria, Málaga, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Rubio-Navarro
authors.affiliation: Department of Cardio-Anaesthesiology, University Hospital Virgen de la Victoria, Málaga, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Cruz-Mañas
keywords: acute renal failure; brain; kidney; levosimendan; preoperative