Preoperative Use of Levosimendan In Cardiac Surgery Patients With Heart Failure Due To Severe Left Ventricular Dysfunction
Öz
Objectives: We aimed to evaluate the clinical and hemodynamic eff ects of preoperative use of levosimendan in cardiac surgery patients with severe left ventricular dysfunction. Study design: Ten patients with poor ventricular function EF ≤30% undergoing cardiac surgery with cardiopulmonary bypass CPB were prospectively enrolled. Patients received levosimendan infusion of 0.1 mcg/kg/min, starting 4 hours before the surgical procedure to be continued for 24 hours. Measurements of ejection fraction were performed preoperatively and postoperatively on the 5th day and 1st month. Cardiac index, pulmonary capillary wedge pressure, systemic vascular resistance index, pulmonary vascular resistance index, mean arterial pressure, central venous pressure, mean pulmonary artery pressure was monitored at the postoperative 0th, 4th, 6th, 12th and 24th hours. Results: All the patients underwent coronary bypass surgery; one patient had aortic valve replacement, one had tricuspid valve repair, one had mitral valve repair and one had left ventricular aneurysmectomy additionally. Mean Euroscore of the group was 6.5±2.7. No postoperative IABP use, stroke, renal failure, major infection and 1 month mortality were observed. Pulmonary vascular resistance was signifi cantly reduced p =0.001 postoperatively. Mean follow up period was 11.6± 5.7 month range: 4–17 month . No late mortality or cardiac reintervention was observed. The ejection fraction at the preoperative, postoperative 1st day and postoperative 1st month were as 27.5±3.1; 37.1±5.4; 40.3±10.7 % respectively p=0.01 . Conclusion: Early use of levosimendan prior to the cardiac operation in patients with heart failure due to poor left ventricular function may improve hemodynamic function and clinical outcome.
Anahtar Kelimeler
Kaynakça
- Raja SG, Rayen BS, Levosimendan in Cardiac Surgery: Current Best Available Evidence. Ann Thorac Surg 2006;81:1536-1546
- Hardy JF, Belisle S. Inotropic support of the heart that fails to successfully wean from cardiopulmonary bypass: the Montreal Heart Institute experience. J Cardiothorac Vasc Anesth 1993;7(suppl 2):33–9.
- Trost JC, Hillis LD. Intra-aortic balloon counterpulsation.Am J Cardiol. 2006:1;97(9):1391-8
- Frishman WH. Advances in positive inotropic therapy: levosimendan. Crit Care Med 2003;31:2408 –9.
- Figgitt DP, Gillies PS, Goa KL. Levosimendan. Drugs 2001; 61:613–27
- Tritapepe L, De Santis V, Vitale D, Santulli M, Morelli A, Nofroni I, Puddu PE, Singer M, Pietropaoli P. Preconditioning eff ects of levosimendan in coronary artery bypass grafting- a pilot study. Br J Anaesth. 2006 Jun;96(6):694-700.
- Rump AF, Acar D, Rosen R, Klaus W. Functional and antiischaemic eff ects of the phosphodiesterase inhibitor levosimendan in isolated rabbit hearts. Pharmacol Toxicol 1994;74:244–8.
- Moher D, Schulz KF, Altman D. The CONSORT Statement: Revised Recommendations for Improving the Quality of Reports of Parallel- Group Randomized Trials. JAMA, 18, 2001—Vol 285, No. 15
- Schiller NB, Shah PM, Crawford M et al. Recommendations for quantitation of the left ventricle by two- dimensional echocardiography. J Am Soc Echocardiogr 1989;2:358-67
- Lehmann A, Boldt J, Lang J, Isgro F, Blome M. Is levosimendan an inoprotective drug in patients with acute coronary syndrome undergoing surgical revascularization? Anasthesiol Intensivmed Notfallmed Schmerzther 2003;38:577– 82.
- Sandell E-P, Nijhawan N, Pagel PS, DC Warltier. Levosimendan enhances cardiac performance in patients following cardiac surgery and cardiopulmonary bypass. Crit Care 2002;6(suppl 1):P142 [abstract].
- Nijhawan N, Nicolosi AC, Montgomery MW, Aggarwal A, Pagel PS, Warltier DC. Levosimendan enhances cardiac performance after cardiopulmonary bypass: a prospective, randomized placebo- controlled trial. J Cardiovasc Pharmacol 1999;34:219 –28.
- Lilleberg J, Nieminen MS, Akkila J, Heikkila L, Kuitunen A, Lehtonen L. Eff ects of a new calcium sensitizer, levosimendan, on haemodynamics, coronary blood fl ow and myocardial substrate utilization early after coronary artery bypass grafting. Eur Heart J 1998;19:660–8.
- Sablotzki A, Friedrich I, Mühling J, Dehne MG, Spillner J, Silber RE, Czeslik E. The systemic infl ammatory response syndrome following cardiac surgery: diff erent expression of proinfl ammatory cytokines and procalcitonin in patients with and without multiorgan dysfunctions. Perfusion. 2002 Mar;17(2):103-9.
- Parish RC, Evans JD. Infl ammation in chronic heart failure. Ann Pharmacother. 2008;42(7):1002-16.
- Miettinen KH, Lassus J, Harjola VP, Siirilä-Waris K, Melin J, Punnonen KR, Nieminen MS, Laakso M, Peuhkurinen KJ. Prognostic role of pro- and anti-infl ammatory cytokines and their polymorphisms in acute decompensated heart failure. Eur J Heart Fail. 2008;10(4):396-403.
- Tasouli A, Papadopoulos K, Antoniou T, Kriaras I, Stavridis G, Degiannis D, Geroulanos S. Effi cacy and safety of perioperative infusion of levosimendan in patients with compromised cardiac function undergoing open-heart surgery: importance of early use. Eur J Cardiothorac Surg. 2007 Oct;32(4):629-33.
- Meyer K, Schipke JD, Klocke RC, Gams E, Korbmacher B. Inotropic, vasodilating and preconditioning actions of levosimendan in the heart. Thorac Cardiovasc Surg. 2008;56(7):379-85.
- Parissis JT, Andreadou I, Bistola V, Paraskevaidis I, Filippatos G, Kremastinos DT. Novel biologic mechanisms of levosimendan and its eff ect on the failing heart. Expert Opin Investig Drugs. 2008;17(8):1143-50.
- du Toit EF, Genis A, Opie LH, Pollesello P, Lochner A. A role for the RISK pathway and K(ATP) channels in pre- and post-conditioning induced by levosimendan in the isolated guinea pig heart. Br J Pharmacol. 2008;154(1):41-50.
Ciddi Sol Ventrikül Disfonksiyonuna Bağlı Kalp Yetersizliği Olan Kalp Cerrahisi Hastalarında Preoperatif Levosimendan Kullanımı
Öz
Amaç: Bu çalışmada ileri derecede sol ventrikül fonksiyon bozukluğuna bağlı kalp yetersizliği olan kalp cerrahisi hastalarında preoperatif levosimendan kullanımının klinik ve hemodinamik etkilerini değerlendirmeyi amaçladık. Çalışma planı: Kardiyopulmoner bypass altında kalp cerrahisi planlanan sol ventrikül ejeksiyon fraksiyonu ≤ %30 olan 10 hasta prospektif olarak çalışmaya dahil edildi. Hastalara operasyondan 4 saat önce başlanıp toplam 24 saat devam edecek şekilde 0.1 mcg/kg/dk dozunda levosimendan uygulandı. Operasyon öncesinde, postoperatif 5. gün ve 1. ayda sol ventrikül ejeksiyon fraksiyonu ölçümleri yapıldı. Postoperatif dönemde 0,4,6,12 ve 24. saatlerde kardiyak indeks, pulmoner kapiller uç basıncı, sistemik vasküler rezistans indeksi, pulmoner vasküler rezistans indeksi, ortalama arteryel basınç, santral venöz basınç, ortalama pulmoner arter basıncı ölçülerek kaydedildi. Bulgular: Tüm hastalara koroner bypass operasyonu yapıldı, ek olarak bir hastada aort kapak replasmanı, bir hastada triküspit kapak tamiri, bir hastada mitral kapak tamiri, bir hastada da sol ventrikül anevrizmektomi işlemi yapıldı. Hastaların ortalama Euroscore puanları 6.5±2.7 idi. Postoperatif dönemde intaaortik balon pompası kullanımı gerekmedi. İnme, böbrek yetmezliği, major infeksiyon ve 1 aylık mortalite gözlenmedi. Pulmoner kapiller uç basıncı postoperatif dönemde istatiksel olarak anlamlı bir şekilde azaldı p =0.001 . Hastaların ortalama takip süresi 11.6± 5.7 ay range: 4–17 idi. Geç dönemde mortalite veya tekrar kardiyak girişim gereksinimi gözlenmedi. Sol ventrikül ejeksiyon fraksiyonu ölçümleri operasyon öncesinde; postoperatif 5. gün ve 1. ayda 27.5±3.1; 37.1±5.4 ve 40.3±10.7 % olarak gözlendi p=0.01 . Sonuç: İleri derecede sol ventrikül fonksiyon bozukluğuna bağlı kalp yetersizliği olan kalp cerrahisi hastalarında operasyon öncesi levosimendan kullanımı hemodinamik fonksiyon ve klinik sonuçları iyileştirebilir.
Anahtar Kelimeler
Kaynakça
- Raja SG, Rayen BS, Levosimendan in Cardiac Surgery: Current Best Available Evidence. Ann Thorac Surg 2006;81:1536-1546
- Hardy JF, Belisle S. Inotropic support of the heart that fails to successfully wean from cardiopulmonary bypass: the Montreal Heart Institute experience. J Cardiothorac Vasc Anesth 1993;7(suppl 2):33–9.
- Trost JC, Hillis LD. Intra-aortic balloon counterpulsation.Am J Cardiol. 2006:1;97(9):1391-8
- Frishman WH. Advances in positive inotropic therapy: levosimendan. Crit Care Med 2003;31:2408 –9.
- Figgitt DP, Gillies PS, Goa KL. Levosimendan. Drugs 2001; 61:613–27
- Tritapepe L, De Santis V, Vitale D, Santulli M, Morelli A, Nofroni I, Puddu PE, Singer M, Pietropaoli P. Preconditioning eff ects of levosimendan in coronary artery bypass grafting- a pilot study. Br J Anaesth. 2006 Jun;96(6):694-700.
- Rump AF, Acar D, Rosen R, Klaus W. Functional and antiischaemic eff ects of the phosphodiesterase inhibitor levosimendan in isolated rabbit hearts. Pharmacol Toxicol 1994;74:244–8.
- Moher D, Schulz KF, Altman D. The CONSORT Statement: Revised Recommendations for Improving the Quality of Reports of Parallel- Group Randomized Trials. JAMA, 18, 2001—Vol 285, No. 15
- Schiller NB, Shah PM, Crawford M et al. Recommendations for quantitation of the left ventricle by two- dimensional echocardiography. J Am Soc Echocardiogr 1989;2:358-67
- Lehmann A, Boldt J, Lang J, Isgro F, Blome M. Is levosimendan an inoprotective drug in patients with acute coronary syndrome undergoing surgical revascularization? Anasthesiol Intensivmed Notfallmed Schmerzther 2003;38:577– 82.
- Sandell E-P, Nijhawan N, Pagel PS, DC Warltier. Levosimendan enhances cardiac performance in patients following cardiac surgery and cardiopulmonary bypass. Crit Care 2002;6(suppl 1):P142 [abstract].
- Nijhawan N, Nicolosi AC, Montgomery MW, Aggarwal A, Pagel PS, Warltier DC. Levosimendan enhances cardiac performance after cardiopulmonary bypass: a prospective, randomized placebo- controlled trial. J Cardiovasc Pharmacol 1999;34:219 –28.
- Lilleberg J, Nieminen MS, Akkila J, Heikkila L, Kuitunen A, Lehtonen L. Eff ects of a new calcium sensitizer, levosimendan, on haemodynamics, coronary blood fl ow and myocardial substrate utilization early after coronary artery bypass grafting. Eur Heart J 1998;19:660–8.
- Sablotzki A, Friedrich I, Mühling J, Dehne MG, Spillner J, Silber RE, Czeslik E. The systemic infl ammatory response syndrome following cardiac surgery: diff erent expression of proinfl ammatory cytokines and procalcitonin in patients with and without multiorgan dysfunctions. Perfusion. 2002 Mar;17(2):103-9.
- Parish RC, Evans JD. Infl ammation in chronic heart failure. Ann Pharmacother. 2008;42(7):1002-16.
- Miettinen KH, Lassus J, Harjola VP, Siirilä-Waris K, Melin J, Punnonen KR, Nieminen MS, Laakso M, Peuhkurinen KJ. Prognostic role of pro- and anti-infl ammatory cytokines and their polymorphisms in acute decompensated heart failure. Eur J Heart Fail. 2008;10(4):396-403.
- Tasouli A, Papadopoulos K, Antoniou T, Kriaras I, Stavridis G, Degiannis D, Geroulanos S. Effi cacy and safety of perioperative infusion of levosimendan in patients with compromised cardiac function undergoing open-heart surgery: importance of early use. Eur J Cardiothorac Surg. 2007 Oct;32(4):629-33.
- Meyer K, Schipke JD, Klocke RC, Gams E, Korbmacher B. Inotropic, vasodilating and preconditioning actions of levosimendan in the heart. Thorac Cardiovasc Surg. 2008;56(7):379-85.
- Parissis JT, Andreadou I, Bistola V, Paraskevaidis I, Filippatos G, Kremastinos DT. Novel biologic mechanisms of levosimendan and its eff ect on the failing heart. Expert Opin Investig Drugs. 2008;17(8):1143-50.
- du Toit EF, Genis A, Opie LH, Pollesello P, Lochner A. A role for the RISK pathway and K(ATP) channels in pre- and post-conditioning induced by levosimendan in the isolated guinea pig heart. Br J Pharmacol. 2008;154(1):41-50.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Research Article |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Mart 2010 |
| Yayımlandığı Sayı | Yıl 2010Sayı: 1 |