Volume 5, Issue 2, March 2019, Page: 51-55
Effect of Levosimendan Infusion 24 Hours Before CABG Surgery in Patients with Impaired Left Ventricular Function on the Need for Postoperative IABP
Sherif Nasr, Department of Cardiothoracic Surgery, Fayoum University, Fayoum, Egypt
Hesham Alkady, Department of Cardiothoracic Surgery, Cairo University, Cairo, Egypt
Ahmed Saber, Department of Cardiothoracic Surgery, Cairo University, Cairo, Egypt
Ahmed Elsharkawy, Department of Cardiothoracic Surgery, Cairo University, Cairo, Egypt
Eman Mahmoud, Department of Cardiology, Fayoum University, Fayoum, Egypt
Received: May 4, 2019;       Accepted: Jun. 2, 2019;       Published: Jun. 12, 2019
DOI: 10.11648/j.ijcts.20190502.15      View  152      Downloads  29
Abstract
Background: Due to their unfavorable outcome, patients with impaired left ventricular function undergoing CABG surgery (LVEF ≤ 35%) are in a real need for optimization of their preoperative status in order to achieve the best possible results. In this retrospective comparative study we analysis our results in patients with impaired LV function after using Levosimendan as a continuous infusion 24 hours prior to CABG surgery regarding the need for postoperative IABP. Patients and methods: We included in this study 103 patients with LVEF ≤ 35% that underwent coronary artery bypass grafting with or without repair of ischemic mitral regurgitation and received Levosimendan infusion 24 hours before surgery in the period between January 2016 and January 2019 in 2 hospitals (Group A). These data were compared to another matched control group of 98 patients with similar conditions that were operated in the same hospitals over a previous period of 3 years but received no Levosimendan infusion preoperatively (Group B). Results: There was a statistically significant difference in the postoperative results in favor of group A regarding the need for IABP application (P-value = 0.013). However there were no statistically significant differences between both groups in concern of duration of inotropic support (P-value = 0.40), duration of mechanical ventilation (P-value = 0.30), total ICU (P-value = 0.20) and hospital stays (P-value = 0.40), incidence of postoperative atrial fibrillation (P-value = 0.50), incidence of major adverse effects, and in-hospital mortality (P-value = 0.20). There was only one in-hospital mortality in each group. Conclusion: According to our study, infusion of Levosimendan 24 hours prior to CABG surgery in patients with impaired left ventricular contractility is safe and effective in reducing the need of IABP application. However Levosimendan infusion did not affect significantly postoperative coarse, incidence of major adverse effects, and in-hospital mortality.
Keywords
CABG Surgery, Levosimendan Infusion, Intra-aortic Balloon Counter-pulsation Pump
To cite this article
Sherif Nasr, Hesham Alkady, Ahmed Saber, Ahmed Elsharkawy, Eman Mahmoud, Effect of Levosimendan Infusion 24 Hours Before CABG Surgery in Patients with Impaired Left Ventricular Function on the Need for Postoperative IABP, International Journal of Cardiovascular and Thoracic Surgery. Vol. 5, No. 2, 2019, pp. 51-55. doi: 10.11648/j.ijcts.20190502.15
Copyright
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reference
[1]
Shahian DM, O’Brien SM, Filardo G, Ferraris VA, Haan CK, Rich JB, Normand SL, DeLong ER, Shewan CM, Dokholyan RS, Peterson ED, Edwards FH, Anderson RP; Society of Thoracic Surgeons Quality Measurement Task Force. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: Part 1–coronary artery bypass grafting surgery. Ann Thorac Surg 2009; 88: S2–22.
[2]
Harrison RW, Hasselblad V, Mehta RH, Levin R, Harrington RA, Alexander JH. Effect of levosimendan on survival and adverse events after cardiac surgery: a meta-analysis. J Cardiothorac Vasc Anesth 2013; 27: 1224–32.
[3]
Kolseth SM, Nordhaug DO, Stenseth R, Sellevold O, Kirkeby-Garstad I, Wahba A. Prophylactic treatment with levosimendan: a retrospective matched-control study of patients with reduced left ventricular function. Eur J Cardiothorac Surg. 2009 Dec; 36: 1024-30.
[4]
Leppikangas H, Järvelä K, Sisto T, Maaranen P, Virtanen M, Lehto P, Karlsson S, Kööbi T, Lindgren L. Preoperative levosimendan infusion in combined aortic valve and coronary bypass surgery. Br J Anaesth. 2011 Mar; 106: 298-304.
[5]
Raja SG, Rayen BS. Levosimendan in Cardiac Surgery: Current Best Available Evidence. Ann Thorac Surg 2006; 81: 1536–46.
[6]
Landoni G, Biondi-Zoccai G, Greco M, Greco T, Bignami E, Morelli A, Guarracino F, Zangrillo A. Effects of levosimendan on mortality and hospitalization. A meta-analysis of randomized controlled studies. Crit Care Med 2012; 40: 634–46.
[7]
Lim JY, Deo SV, Rababa'h A, Altarabsheh SE, Cho YH, Hang D, McGraw M, Avery EG, Markowitz AH, Park SJ. Levosimendan reduces mortality in adults with left ventricular dysfunction undergoing cardiac surgery: a systematic review and metaanalysis. J Card Surg 2015; 30: 547–54.
[8]
Mehta RH, Leimberger JD, van Diepen S, Meza J, Wang A, Jankowich R, Harrison RW, Hay D, Fremes S, Duncan A, Soltesz EG, Luber J, Park S, Argenziano M, Murphy E, Marcel R, Kalavrouziotis D, Nagpal D, Bozinovski J, Toller W, Heringlake M, Goodman SG, Levy JH, Harrington RA, Anstrom KJ, Alexander JH; LEVO-CTS Investigators. Levosimendan in patients with left ventricular dysfunction undergoing cardiac surgery. N Engl J Med 2017; 376: 2032–42.
[9]
Elbadawi A, Elgendy IY, Saad M, Megaly M, Mentias A, Abuzaid AS, Shahin HI, Goswamy V, Abowali H, London B. Meta-Analysis of Trials on Prophylactic Use of Levosimendan in Patients Undergoing Cardiac Surgery. Ann Thorac Surg 2018 Mar 21.
[10]
Molfetta PD, Gregorini R, Fiore C, Santarpino G. Is There Still Room For The Prophylactic Use Of Levosimendan In Cardiac Surgery? Ann Thorac Surg 2018.
[11]
Anastasiadis K, Antonitsis P, Vranis K, Kleontas A, Asteriou C, Grosomanidis V, Tossios P, Argiriadou H. Effectiveness of prophylactic levosimendan in patients with impaired left ventricular function undergoing coronary artery bypass grafting: a randomized pilot study. Interactive CardioVascular and Thoracic Surgery 2016; 1–8.
[12]
Toller W, Heringlake M, Guarracino F, Algotsson L, Alvarez J, Argyriadou H, Ben-Gal T, Černý V, Cholley B, Eremenko A, Guerrero-Orriach JL, Järvelä K, Karanovic N, Kivikko M, Lahtinen P, Lomivorotov V, Mehta RH, Mušič Š, Pollesello P, Rex S, Riha H, Rudiger A, Salmenperä M, Szudi L, Tritapepe L, Wyncoll D, Öwall A. Preoperative and perioperative use of levosimendan in cardiac surgery: European expert opinion. Int J Cardiol. 2015; 184: 323-36.
[13]
Kivikko M, Antila S, Eha J, Lehtonen L, Pentikäinen PJ. Pharmacokinetics of levosimendan and its metabolites during and after a 24-hour continuous infusion in patients with severe heart failure. Int J Clin Pharmacol Ther 2002; 40: 465–71.
[14]
Pilarczyk K, Boening A, Jakob H, Langebartels G, Markewitz A, Haake N, Heringlake M, Trummer G. Preoperative intra-aortic counterpulsation in high-risk patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials. Eur J Cardiothorac Surg 2016; 49: 5–17.
[15]
Kandasamy A, Simon HA, Murthy P, Annadurai M, Ali MM, Ramanathan G. Comparison of levosimendan versus dobutamine in patients with moderate to severe left ventricular dysfunction undergoing off-pump coronary artery bypass grafting: a randomized prospective study. Ann Card Anaesth 2017; 20: 200.
[16]
Barisin S, Husedzinovic I, Sonicki Z, Bradic N, Barisin A, Tonkovic D. Levosimendan in off-pump coronary artery bypass: a four-times masked controlled study. J Cardiovasc Pharmacol 2004; 44: 703– 8.
Browse journals by subject