Effects of levosimendan on patients undergoing valve replacement_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SHENG Wei ¹ ,  LI Na ² , CHI Yifan ¹ , NIU Zhaozhuo ¹ , ZHANG Wenfeng ¹ , WU Jiantao ¹ , LI Haoyou ¹ , WANG Tianyi ¹ ,  HUANG Qiang ¹

1. Department of Cardiovascular Surgery, Qingdao Municipal Hospital, Medical College of Qingdao University, Qingdao, 266071, Shandong, P.R.China;
2. Department of Emergency Cardiology, Qingdao Municipal Hospital, Medical College of Qingdao University, Qingdao, 266071, Shandong, P.R.China;

Corresponding author：

HUANG Qiang, Email: hqhuangqiang@163.com

Keywords：

Levosimendan; valve replacement; cardiac function

DOI：

10.7507/1007-4848.201809036

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Objective To investigate the effect of postoperative use of levosimendan on patients with valve replacement.Method Patients with valvular diseases who underwent valve replacement were prospectively enrolled during Jan 2014 to May 2018 in Qingdao Municipal Hospital, randomized to a levosimendan-treated group (n=93) and a control group (n=92) preoperatively. Patients in both groups underwent the same routine treatment preoperatively and postoperatively. In addition, patients in the levosimendan-treated group underwent levosimendan intravenous infusion 24 hours after entering ICU postoperatively. The clinical effect of the two groups was compared.Results Compared to the control group, the cardiac output(CO, 5.2±1.0 L/min vs. 4.4±1.1 L/min on the seventh day after surgery) and left ventricular ejection fraction (LVEF, 55.7%±2.5% vs. 50.5%±2.2% on the seventh day after surgery) of levosimendan-treated group were increased significantly at different time points(1 day, 3 days and 7 days after surgery)(P<0.05), and the brain natriuetic peptid (BNP) level (312.5±34.6 pg/ml vs. 455.4±45.2 pg/ml on the seventh day after surgery) was less than that of the control group (P<0.05). The dosage (11.5±1.8 mg/kg vs. 20.4±2.1 mg/kg) and administration time of vasoactive agents in the levosimendan-treated group were significantly lower or shorter than those in the control group (70.4±11.2 h vs. 110.5±12.1 h, P<0.05). The ICU stay length, and the total incidence of adverse events were less than those of the control group (P<0.05).Conclusion Postoperative use of levosimendan immediately after surgery can significantly improve the cardiac function status of patients who underwent valve replacement, reduce the dosage of vasoactive agents, shorten the time of ICU hospitalization, reduce the incidence of adverse events and enhance the patient’s recovery after valve replacement.

Citation： SHENG Wei, LI Na, CHI Yifan, NIU Zhaozhuo, ZHANG Wenfeng, WU Jiantao, LI Haoyou, WANG Tianyi, HUANG Qiang. Effects of levosimendan on patients undergoing valve replacement. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(7): 693-697. doi: 10.7507/1007-4848.201809036 Copy

1.	骆璇, 薛云星, 田聪聪, 等. 远端缺血预处理在心脏瓣膜手术中的心肌保护作用. 中国胸心血管外科临床杂志, 2016, 23(8): 769-772.
2.	牛新荣, 陈东. 心脏瓣膜置换术后重度低心排综合征临床治疗. 心肺血管病杂志, 2017, 36(3): 211-213.
3.	胡寿祥, 方填源, 赖及隆, 等. IABP 在重症心脏瓣膜置换术的应用. 中国心血管病研究, 2016, 14(7): 620-622.
4.	陈祖君, 裴锋博, 吴慧, 等. 左西孟旦对重症冠状动脉旁路移植患者术后血流动力学的影响. 中华胸心血管外科杂志, 2017, 2015, 31(5): 297-299.
5.	黄园琴, 李颖, 危宇, 等. 左西孟旦与多巴酚丁胺应用于重症瓣膜病患者围术期效果的随机对照试验. 中国胸心血管外科临床杂志, 2015, (5): 423-427.
6.	Cao Z, Shen R, Zhang X, et al. Effects of remote ischemic preconditioning on acute myocardial injury in patients undergoing valve replacement. Ir J Med Sci, 2017, 186(4): 889-893.
7.	De Hert S, Moerman A. Myocardial injury and protection related to cardiopulmonary bypass. Best Pract Res Clin Anaesthesiol, 2015, 29(2): 137-149.
8.	Yamazaki Y, Oba K, Matsui Y, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in adults after cardiac surgery with cardiopulmonary bypass. J Anesth, 2018, 32(2): 167-173.
9.	Garcia RU, Walters HL 3rd, Delius RE, et al. Vasoactive inotropic score (VIS) as biomarker of short-term outcomes in adolescents after cardiothoracic surgery. Pediatr Cardiol, 2016, 37(2): 271-277.
10.	Kandasamy A, Simon HA, Murthy P, et al. 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(2): 200-206.
11.	Putzu A, Clivio S, Belletti A, et al. Perioperative levosimendan in cardiac surgery: A systematic review with meta-analysis and trial sequential analysis. Int J Cardiol, 2018, 15(251): 22-31.
12.	Atalay H, Temizturk Z, Altinsoy HB, et al. Levosimendan use increases cardiac performance after coronary artery bypass grafting in end-stage renal disease patients. Heart Surg Forum, 2016, 19(5): E230-E236.
13.	Anastasiadis K, Antonitsis P, Vranis K, et al. Effectiveness of prophylactic levosimendan in patients with impaired left ventricular function undergoing coronary artery bypass grafting: a randomized pilot study. Interact Cardiovasc Thorac Surg, 2016, 23(5): 740-747.
14.	Zhou C, Gong J, Chen D, et al. Levosimendan for prevention of acute kidney injury after cardiac surgery: A meta-analysis of randomized controlled trials. Am J Kidney Dis, 2016, 67(3): 408-416.
15.	Qiang H, Luo X, Huo JH, et al. Perioperative use of levosimendan improves clinical outcomes in patients after cardiac surgery: a systematic review and meta-analysis. J Cardiovasc Pharmacol, 2018, 72(1): 11-18.
16.	Lee CT, Lin YC, Yeh YC, et al. Effects of levosimendan for perioperative cardiovascular dysfunction in patients receiving cardiac surgery: a meta-analysis with trial sequential analysis. Intensive Care Med, 2017, 43(12): 1929-1930.
17.	Chen QH, Zheng RQ, Lin H, et al. Effect of levosimendan on prognosis in adult patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials. Crit Care, 2017, 21(1): 253.
18.	Abacilar AF, Dogan OF. Levosimendan use decreases atrial fibrillation in patients after coronary artery bypass grafting: a pilot study. Heart Surg Forum, 2013, 16(5): E287-E294.
19.	Suita K, Fujita T, Cai W, et al. Vidarabine, an anti-herpesvirus agent, prevents catecholamine-induced arrhythmias without adverse effect on heart function in mice. Pflugers Arch, 2018, 470(6): 923-935.

1. 骆璇, 薛云星, 田聪聪, 等. 远端缺血预处理在心脏瓣膜手术中的心肌保护作用. 中国胸心血管外科临床杂志, 2016, 23(8): 769-772.
2. 牛新荣, 陈东. 心脏瓣膜置换术后重度低心排综合征临床治疗. 心肺血管病杂志, 2017, 36(3): 211-213.
3. 胡寿祥, 方填源, 赖及隆, 等. IABP 在重症心脏瓣膜置换术的应用. 中国心血管病研究, 2016, 14(7): 620-622.
4. 陈祖君, 裴锋博, 吴慧, 等. 左西孟旦对重症冠状动脉旁路移植患者术后血流动力学的影响. 中华胸心血管外科杂志, 2017, 2015, 31(5): 297-299.
5. 黄园琴, 李颖, 危宇, 等. 左西孟旦与多巴酚丁胺应用于重症瓣膜病患者围术期效果的随机对照试验. 中国胸心血管外科临床杂志, 2015, (5): 423-427.
6. Cao Z, Shen R, Zhang X, et al. Effects of remote ischemic preconditioning on acute myocardial injury in patients undergoing valve replacement. Ir J Med Sci, 2017, 186(4): 889-893.
7. De Hert S, Moerman A. Myocardial injury and protection related to cardiopulmonary bypass. Best Pract Res Clin Anaesthesiol, 2015, 29(2): 137-149.
8. Yamazaki Y, Oba K, Matsui Y, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in adults after cardiac surgery with cardiopulmonary bypass. J Anesth, 2018, 32(2): 167-173.
9. Garcia RU, Walters HL 3rd, Delius RE, et al. Vasoactive inotropic score (VIS) as biomarker of short-term outcomes in adolescents after cardiothoracic surgery. Pediatr Cardiol, 2016, 37(2): 271-277.
10. Kandasamy A, Simon HA, Murthy P, et al. 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(2): 200-206.
11. Putzu A, Clivio S, Belletti A, et al. Perioperative levosimendan in cardiac surgery: A systematic review with meta-analysis and trial sequential analysis. Int J Cardiol, 2018, 15(251): 22-31.
12. Atalay H, Temizturk Z, Altinsoy HB, et al. Levosimendan use increases cardiac performance after coronary artery bypass grafting in end-stage renal disease patients. Heart Surg Forum, 2016, 19(5): E230-E236.
13. Anastasiadis K, Antonitsis P, Vranis K, et al. Effectiveness of prophylactic levosimendan in patients with impaired left ventricular function undergoing coronary artery bypass grafting: a randomized pilot study. Interact Cardiovasc Thorac Surg, 2016, 23(5): 740-747.
14. Zhou C, Gong J, Chen D, et al. Levosimendan for prevention of acute kidney injury after cardiac surgery: A meta-analysis of randomized controlled trials. Am J Kidney Dis, 2016, 67(3): 408-416.
15. Qiang H, Luo X, Huo JH, et al. Perioperative use of levosimendan improves clinical outcomes in patients after cardiac surgery: a systematic review and meta-analysis. J Cardiovasc Pharmacol, 2018, 72(1): 11-18.
16. Lee CT, Lin YC, Yeh YC, et al. Effects of levosimendan for perioperative cardiovascular dysfunction in patients receiving cardiac surgery: a meta-analysis with trial sequential analysis. Intensive Care Med, 2017, 43(12): 1929-1930.
17. Chen QH, Zheng RQ, Lin H, et al. Effect of levosimendan on prognosis in adult patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials. Crit Care, 2017, 21(1): 253.
18. Abacilar AF, Dogan OF. Levosimendan use decreases atrial fibrillation in patients after coronary artery bypass grafting: a pilot study. Heart Surg Forum, 2013, 16(5): E287-E294.
19. Suita K, Fujita T, Cai W, et al. Vidarabine, an anti-herpesvirus agent, prevents catecholamine-induced arrhythmias without adverse effect on heart function in mice. Pflugers Arch, 2018, 470(6): 923-935.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effects of levosimendan on patients undergoing valve replacement

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