Document Detail


Levosimendan in aortic valve surgery: cardiac performance and recovery.
MedLine Citation:
PMID:  18922425     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The aim of the present study was to test the hypothesis that levosimendan has beneficial effects on cardiac performance and that the need for other vasoactive medications during and after cardiac surgery would be reduced by levosimendan in patients with severe aortic stenosis (AS) and left ventricular (LV) hypertrophy. DESIGN: A prospective, randomized, double-blind, placebo-controlled clinical study. SETTING: A university hospital. PARTICIPANTS: Twenty-four patients scheduled for aortic valve surgery with or without coronary artery bypass graft surgery were enrolled in the study. INTERVENTIONS: Twelve patients received a 24-hour levosimendan infusion (0.2 microg/kg/min) beginning after the induction of anesthesia, and 12 patients received a placebo infusion. MEASUREMENTS AND MAIN RESULTS: Left ventricular ejection fraction, measured before study drug infusion, was lower in the treatment group than in the control group (42% v 54%, p = 0.015). After sternum closure, the ejection fraction dropped in the control group but was maintained at the same level in the treatment group (45% v 48%, not significant). Mixed venous and central venous saturations were significantly lower in the treatment group than in the control group at the baseline, but after the beginning of the study drug infusion, the groups were similar throughout the rest of the follow-up period. The treatment group required more norepinephrine during the operation and less nitroprusside postoperatively. CONCLUSIONS: Low output is a result of myocardial stunning and is common after cardiopulmonary bypass. According to the present results, levosimendan may be useful in patients with severe AS and LV hypertrophy because it may prevent LV function from dropping to a critically low level postoperatively. Levosimendan causes vasodilation and thereby decreases mean arterial pressure, but this can be controlled with the use of norepinephrine.
Authors:
Kati Järvelä; Pasi Maaranen; Tero Sisto; Esko Ruokonen
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Journal of cardiothoracic and vascular anesthesia     Volume:  22     ISSN:  1532-8422     ISO Abbreviation:  J. Cardiothorac. Vasc. Anesth.     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-10-16     Completed Date:  2009-01-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9110208     Medline TA:  J Cardiothorac Vasc Anesth     Country:  United States    
Other Details:
Languages:  eng     Pagination:  693-8     Citation Subset:  IM    
Affiliation:
Heart Center, Pirkanmaa Hospital District, Tampere, Finland. kati.jarvela@pshp.fi
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MeSH Terms
Descriptor/Qualifier:
Aged
Aortic Valve / surgery*
Calcium / metabolism
Cardiopulmonary Bypass
Cardiotonic Agents / pharmacology*
Double-Blind Method
Female
Humans
Hydrazones / pharmacology*
Male
Middle Aged
Oxygen / blood
Prospective Studies
Pyridazines / pharmacology*
Stroke Volume / drug effects
Ventricular Function, Left / drug effects
Chemical
Reg. No./Substance:
0/Cardiotonic Agents; 0/Hydrazones; 0/Pyridazines; 131741-08-7/simendan; 7440-70-2/Calcium; 7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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