Document Detail


Preoperative levosimendan infusion in combined aortic valve and coronary bypass surgery.
MedLine Citation:
PMID:  21258075     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Cardiopulmonary bypass may have detrimental effects on intestinal function and decrease the concentrations of the active, long-acting metabolites of levosimendan, an inodilator used to improve cardiac function. The aim of this study was to evaluate the haemodynamic effects of preoperative levosimendan in patients undergoing high-risk cardiac surgery.
METHODS: Twenty-four patients were randomized to receive levosimendan (12 µg bolus followed by an infusion of 0.2 µg kg(-1) min(-1)) or a placebo 24 h before surgery. The inclusion criteria were left ventricular ejection fraction (LVEF) <50% or LV hypertrophy indicated by a wall thickness of >12 mm. Haemodynamics were recorded every hour for 24 h (pulmonary artery catheter) and daily until postoperative day 4 (whole-body impedance cardiography). Doppler echocardiography with tissue Doppler imaging was used to assess systolic and diastolic cardiac function.
RESULTS: The cardiac index (CI) and stroke volume index (SI) were higher in the levosimendan group (LG) for the 4 day postoperative period (P<0.05); on the fourth postoperative day, the CI was 3.0 litre m(-2) min(-1) in the LG compared with 2.4 litre m(-2) min(-1) in the control group (CG) and the SI was 30 vs 25 ml m(-2), respectively. The LVEF measured at baseline and on the fourth postoperative morning decreased in the CG, but was maintained in the LG.
CONCLUSIONS: Levosimendan improved haemodynamics compared with a placebo in patients undergoing high-risk cardiac surgery. The concentrations of levosimendan's metabolites were higher compared with earlier studies using perioperative dosing.
Authors:
H Leppikangas; K Järvelä; T Sisto; P Maaranen; M Virtanen; P Lehto; S Karlsson; T Kööbi; L Lindgren
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2011-01-21
Journal Detail:
Title:  British journal of anaesthesia     Volume:  106     ISSN:  1471-6771     ISO Abbreviation:  Br J Anaesth     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-02-14     Completed Date:  2011-03-23     Revised Date:  2011-08-30    
Medline Journal Info:
Nlm Unique ID:  0372541     Medline TA:  Br J Anaesth     Country:  England    
Other Details:
Languages:  eng     Pagination:  298-304     Citation Subset:  IM    
Affiliation:
Department of Anaesthesia, Tampere University Hospital, PO Box 2000, Tampere 33521, Finland. heli.leppikangas@pshp.fi
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT01210976
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Aortic Valve / surgery*
Cardiac Output / drug effects
Cardiotonic Agents / administration & dosage,  blood,  pharmacology*
Coronary Artery Bypass*
Echocardiography, Doppler
Female
Heart Valve Prosthesis Implantation*
Humans
Hydrazones / administration & dosage,  blood,  pharmacology*
Male
Middle Aged
Postoperative Period
Preoperative Care / methods
Prospective Studies
Pyridazines / administration & dosage,  blood,  pharmacology*
Stroke Volume / drug effects
Chemical
Reg. No./Substance:
0/Cardiotonic Agents; 0/Hydrazones; 0/Pyridazines; 131741-08-7/simendan
Comments/Corrections
Comment In:
Br J Anaesth. 2011 Aug;107(2):276-7; author reply 277   [PMID:  21757557 ]

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


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