An Evaluation on the Effect of Preoperative Levosimendan Administration as an Inotropic Agent in Patients Undergoing Open Heart Surgery with Poor Ventricular Function

Research Article

Ann Surg Perioper Care. 2016; 1(2): 1009.

An Evaluation on the Effect of Preoperative Levosimendan Administration as an Inotropic Agent in Patients Undergoing Open Heart Surgery with Poor Ventricular Function

Altun G¹*, Hemsinli D², Pulathan Z¹, Ozdemir AC¹, Mutlu H¹ and Civelek A³

¹Department of Cardiovascular Surgery, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey

²Department of Cardiovascular Surgery, Kanuni Education and Research Hospital, Trabzon, Turkey

³Department of Cardiovascular Surgery, Medical Park Hospital, Ordu, Turkey

*Corresponding author: Gokalp Altun, Department of Cardiovascular Surgery, Faculty of Medicine, Karadeniz Technical University, 61080, Trabzon, Turkey

Received: October 06, 2016; Accepted: November 01, 2016; Published: November 03, 2016

Abstract

Aim: Nowadays, we frequently encounter with articles related with preoperative use of Levosimendan in literature. Aim of this paper was to present our clinical experience which was in accordance with the literature rather than comparing or suggesting new clinical data.

Background and Objectives: Most important preoperative risk factor in cardiac surgery is poor ventricular function which directly affects morbidity and mortality. An effective agent named Levosimendan has inotropic and myocardial anti-ischemic effects without increasing myocardial oxygen demand. In this paper, we aimed to present our experience with levosimendan infusion started at 24 hours before operation in patients undergoing open heart surgery with poor ventricular function.

Subjects and Methods: Patients underwent cardiac surgery in our clinic between August 2009-August 2015 were retrospectively evaluated. Among them, 26 patients whose preoperative left ventricular ejection fraction (LVEF) value below 30% were enrolled. These patients had been receiving Levosimendan after admitted to intensive care unit at 24 hours before operation according to our clinical protocol. Pre-operative and post-operative characteristics of patients were collected.

Results: All patients weaned from cardiopulmonary bypass (CPB) without complications. There was no intraoperative or early postoperative mortality. Post-operative EF values were 32% and 37% at first postoperative week and first postoperative month; respectively.

Conclusion: Both of our results and our clinical experience suggested that Levosimendan use during early preoperative period in these patients with high risk is more advantageous than administration during other periods.

Keywords: Inotropic Agent; Levosimendan; Open Heart Surgery; Preoperative Use; Poor Ventricular Function

Introduction

Patients who will undergo open heart surgery are usually presented to the surgeon with various risk factors. Most important risk factor of these patients is Low Ventricular Ejection Fraction (LoVEF). This condition is directly related with perioperative mortality and morbidity [1,2]. These patients with high risk may experience serious problems during weaning from cardiopulmonary bypass (CPB) and through postoperative intensive care period [3].

It is aimed that obtaining highest benefit from surgery by providing some inotropic or mechanical supports to the patients undergoing cardiac operation with poor ventricular function. For this purpose, various agents like dopamine, dobutamine, noradrenaline etc. have been used. However; administration of these agents has risks such as increased myocardial ischemia. Recently, a new drug named Levosimendan is commonly used as an inotropic support.

Levosimendan increases contractility by increasing sensitivity of cardiac myofibrilles to the calcium ion. In addition, it also shows vasodilatator effect by opening ATP-sensitive potassium channels (KATP channels) with only insignificant decrease on mean arterial systolic pressure. During performing these effects; it does not increase oxygen demand of myocardium [4].

We operated elective cases with LoVEF (EF=30%) who will undergo open heart surgery by starting levosimendan infusion for 24 hours before surgery. Also, we retrospectively evaluated these patients and literature related with levosimendan administration. In literature, we observed growing evidence from many recent studies suggesting superior beneficial effects of levosimendan infusion starting at preoperative period in patients undergoing cardiac surgery with LoVEF. In addition; levosimendan infusion starting at preoperative period was seem to have additional beneficial effects on parameters such as glomerular filtration rate, troponin levels etc. which all of them have utmost importance in cardiovascular patients with multiple comorbidities. Therefore; we aimed to present our experience with preoperative levosimendan administration in patients with multiple comorbidities as well as comparing our results with related literature in this study.

Subjects and Methods

Patient population

A total of 642 patients underwent cardiac surgery in our clinic between August 2009-August 2015 was retrospectively evaluated. Among them, patients whose preoperative left ventricular ejection fraction (LVEF) value below 30% were enrolled. These patients had been receiving Levosimendan (Simdax©, 2.5mg/ml, Daiichi-Sankyo) infusion (10μg/kg/10min. loading dose followed by 0.1μg/kg/min continuous infusion) after admitted to intensive care unit at 24 hours before operation according to our clinical protocol. Pre-operative and post-operative characteristics of patients were collected (Table 1-2).

Citation: Altun G, Hemsinli D, Pulathan Z, Ozdemir AC, Mutlu H and Civelek A. An Evaluation on the Effect of Preoperative Levosimendan Administration as an Inotropic Agent in Patients Undergoing Open Heart Surgery with Poor Ventricular Function. Ann Surg Perioper Care. 2016; 1(2): 1009.