Document Detail


A randomized trial evaluating different modalities of levosimendan administration in cardiac surgery patients with myocardial dysfunction.
MedLine Citation:
PMID:  18922426     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To evaluate the effects of 2 different administration modalities of levosimendan (start before cardiopulmonary bypass [CPB] and at the end of CPB) compared with a standard treatment with milrinone started at the end of CPB in cardiac surgery patients with a preoperative ejection fraction <30%.
DESIGN: A prospective study.
SETTING: A university hospital.
PARTICIPANTS: Sixty patients undergoing elective cardiac surgery with CPB.
INTERVENTIONS: Patients were randomly assigned to 3 different treatment options for weaning from CPB after cardiac surgery. Group A received milrinone, 0.5 microg/kg/min, after the release of the aortic cross-clamp; group B received levosimendan, 0.1 microg/kg/min, after the induction of anesthesia; and in group C, levosimendan, 0.1 microg/kg/min, was started immediately after the release of the aortic cross-clamp. In all patients, additional dobutamine, 5 microg/kg/min, was initiated after the release of the aortic cross-clamp. Norepinephrine maintained mean arterial pressure constant.
MEASUREMENTS AND MAIN RESULTS: Stroke volume after surgery was initially higher than at baseline in all groups and highest in group B. Stroke volume declined 12 hours after surgery in group A but not in groups B and C (p < 0.05 between groups), despite similar filling pressures. Four patients in group A, none in group B, and 1 in group C died within 30 days of surgery. Postoperative atrial fibrillation was observed in 10 patients in group A, 7 patients in group C, and only 1 in group B (p < 0.01). No differences were observed in postoperative troponin I release among groups.
CONCLUSION: In the conditions of the present study, starting the levosimendan treatment before CPB was associated with a higher initial postoperative stroke volume and a lower incidence of postoperative atrial fibrillation, but had no effect on the extent of postoperative troponin I release.
Authors:
Stefan G De Hert; Suraphong Lorsomradee; Hervé vanden Eede; Stefanie Cromheecke; Philippe J Van der Linden
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Retracted Publication     Date:  2008-05-14
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:  2011-11-09    
Medline Journal Info:
Nlm Unique ID:  9110208     Medline TA:  J Cardiothorac Vasc Anesth     Country:  United States    
Other Details:
Languages:  eng     Pagination:  699-705     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands. s.g.dehert@amc.uva.nl
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiac Surgical Procedures*
Cardiopulmonary Bypass
Cardiotonic Agents / administration & dosage*
Female
Humans
Hydrazones / administration & dosage*
Male
Middle Aged
Milrinone / therapeutic use
Prospective Studies
Pyridazines / administration & dosage*
Stroke Volume / drug effects
Troponin I / blood
Chemical
Reg. No./Substance:
0/Cardiotonic Agents; 0/Hydrazones; 0/Pyridazines; 0/Troponin I; 131741-08-7/simendan; 78415-72-2/Milrinone
Comments/Corrections
Comment In:
J Cardiothorac Vasc Anesth. 2009 Oct;23(5):757-8   [PMID:  19101169 ]
J Cardiothorac Vasc Anesth. 2010 Feb;24(1):210   [PMID:  19264513 ]
Retraction In:
J Cardiothorac Vasc Anesth. 2011 Oct;25(5):897   [PMID:  22059234 ]

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


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