Effectiveness of prophylactic levosimendan in patients with impaired left ventricular function undergoing coronary artery bypass grafting: a randomized pilot study

Autor: Paschalis Tossios, Konstantinos Vranis, Vassilios Grosomanidis, Athanassios Kleontas, Kyriakos Anastasiadis, Christos Asteriou, Helena Argiriadou, Polychronis Antonitsis
Rok vydání: 2015
Předmět:
Pulmonary and Respiratory Medicine
Cardiac function curve
Male
medicine.medical_specialty
Cardiotonic Agents
Cardiac index
Cardiac Output
Low
Pilot Projects
Coronary Artery Disease
030204 cardiovascular system & hematology
Placebo
Loading dose
Ventricular Function
Left
03 medical and health sciences
Ventricular Dysfunction
Left
0302 clinical medicine
Postoperative Complications
Double-Blind Method
Internal medicine
Medicine
Humans
Prospective Studies
Coronary Artery Bypass
Pulmonary wedge pressure
Infusions
Intravenous
Finland
Simendan
Tomography
Emission-Computed
Single-Photon
Ejection fraction
Dose-Response Relationship
Drug
business.industry
Incidence
Hydrazones
Stroke Volume
Levosimendan
Perioperative
Middle Aged
Pyridazines
Survival Rate
030228 respiratory system
Anesthesia
Cardiology
Surgery
Female
Cardiology and Cardiovascular Medicine
business
medicine.drug
Follow-Up Studies
Zdroj: Interactive cardiovascular and thoracic surgery. 23(5)
ISSN: 1569-9285
Popis: OBJECTIVES Perioperative low cardiac output syndrome occurs in 3-14% of patients undergoing isolated coronary artery bypass grafting (CABG), leading to significant increase in major morbidity and mortality. Considering the unique pharmacological and pharmacokinetic properties of levosimendan, we conducted a prospective, double-blind, randomized pilot study to evaluate the effectiveness of prophylactic levosimendan in patients with impaired left ventricular function undergoing CABG. METHODS Thirty-two patients undergoing CABG with low left ventricular ejection fraction (LVEF ≤ 40%) were randomized to receive either a continuous infusion of levosimendan at a dose of 0.1 μg/kg/min for 24 h without a loading dose or a placebo. The primary outcome of the study was the change in the LVEF assessed with transthoracic echocardiography on the seventh postoperative day. Secondary outcomes included the physiological and clinical effects of levosimendan. RESULTS All patients tolerated preoperative infusion of levosimendan well. The LVEF improved in both groups; this increase was statistically significant in the levosimendan group (from 35.8 ± 5% preoperatively to 42.8 ± 7.8%, P = 0.001) compared with the control group (from 37.5 ± 3.4% preoperatively to 41.2 ± 8.3%, P = 0.1). The cardiac index, SvO2, pulmonary capillary wedge pressure and right ventricular stroke work index showed a similar trend, which was optimized in patients treated with levosimendan. Moreover, an increase in extravascular lung water was noticed in this group during the first 24 h after surgery. CONCLUSIONS This pilot study shows that prophylactic levosimendan infusion is safe and effective in increasing the LVEF postoperatively in patients with impaired cardiac function undergoing coronary surgery. This finding may be translated to 'optimizing' patients' status before surgery.
Databáze: OpenAIRE
Externí odkaz: