Comparative Effect of Levosimendan and Milrinone in Cardiac Surgery Patients With Pulmonary Hypertension and Left Ventricular Dysfunction.
OBJECTIVE
To compare the effects of levosimendan with milrinone in cardiac surgical patients with pulmonary hypertension and left ventricular dysfunction.


METHODS
A prospective, randomized study.


METHODS
Tertiary care teaching hospital.


METHODS
The study included patients with valvular heart disease and pulmonary artery hypertension undergoing valve surgery.


METHODS
Forty patients were allocated randomly to receive either milrinone, 50 µg/kg bolus followed by infusion at a rate of 0.5 µg/kg/min (group 1), or levosimendan, 10 µg/kg bolus followed by infusion at a rate of 0.1 µg/kg/min (group 2) for 24 hours after surgery.


RESULTS
Hemodynamic parameters were measured using a pulmonary artery catheter, and biventricular functions were assessed using echocardiography. Mean pulmonary artery pressures and the pulmonary vascular resistance index were comparable between the 2 groups at several time points in the intensive care unit. Biventricular function was comparable between both groups. Postcardiopulmonary bypass right ventricular systolic and diastolic functions decreased in both groups compared with baseline, whereas 6 hours postbypass left ventricular ejection fraction improved in patients with stenotic valvular lesions. Levosimendan use was associated with higher heart rate, increased cardiac index, decreased systemic vascular resistance index, and increased requirement of norepinephrine infusion compared with milrinone.


CONCLUSIONS
The results of this study demonstrated that levosimendan was not clinically better than milrinone. Levosimendan therapy resulted in a greater increase in heart rate, decrease in systemic vascular resistance, and a greater need for norepinephrine than in patients who received milrinone.
Department of Anaesthesia and Intensive Care, Chandigarh, India.
Abhi
A
Mishra
Department of Anaesthesia and Intensive Care, Chandigarh, India. Electronic address: bhupeshkr@yahoo.com.
Bhupesh
B
Kumar
Department of Anaesthesia and Intensive Care, Chandigarh, India.
Vikas
V
Dutta
Department of Anaesthesia and Intensive Care, Chandigarh, India.
V K
VK
Arya
Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Anand Kumar
AK
Mishra
D000328:Adult; D001021:Aortic Valve / Q000601:surgery; D062186:Arterial Pressure / Q000187:drug effects / Q000502:physiology; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000627:therapeutic use*; D008943:Mitral Valve / Q000601:surgery; D009638:Norepinephrine / Q000008:administration & dosage; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000503:physiopathology; D011724:Pyridazines / Q000627:therapeutic use*; D000077464:Simendan; D014655:Vascular Resistance / Q000187:drug effects / Q000502:physiology; D014665:Vasodilator Agents / Q000627:therapeutic use*; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology
D006835:Hydrazones; D011724:Pyridazines; D014665:Vasodilator Agents; D000077464:Simendan; D020105:Milrinone; D009638:Norepinephrine
biventricular function; levosimendan; milrinone; pulmonary artery hypertension; valvular heart surgery