Levosimendan versus Milrinone in Improving Pulmonary Hypertension after Cardiac Surgery

Abstract Background Pulmonary hypertension is a multifactorial disease with a high morbidity and mortality, right ventricular function is the most important predictor of morbidity and mortality in patients suffering from pulmonary hypertension. Milrinone, a phosphodiesterase III inhibitor is commonly used during post cardiopulmonary bypass (CPB) period in combination with adrenaline or noradrenaline to decrease pulmonary artery pressure and to provide synergistic positive inotropic effect. Levosimendan is a calcium sensitizing agent with inotropic, pulmonary vasodilatory, and cardioprotective properties. This study compared levosimendan with milrinone in improving pulmonary hypertension after cardiac surgeries. Objective To compare between levosimendan and milrinone in improving pulmonary hypertension after cardiac surgeries. Patients and Methods In this study 40 Patients were assigned randomly by using a computer – generated table of random numbers, placing them in sealed envelopes, into two groups: Group M: 20 Patients were received milrinone Group L:20 Patients were received levosimandan. Results In this study we compared levosimendan vs milrinone, in levosimendan group there was more significant increase of post operative TAPSE, in milrnone group there was more significant decrease of PAP and RVSP. There was statistically significant difference groups received milrinone in pre, post operative AST, ALT as there was increase in post operative AST and ALT, groups were compared in demographic data (in terms of age, sex, weight and height) and there was no statistically significant difference between groups, were compared as regard CPB and type of surgery and there was no statistically significant difference between groups, were compared in post operative data (in terms of systolic, diastolic blood pressure, heart rate, SPO2, CVP, UOP and extubation time), there was no statistically significant difference between groups, were compared in kidney function (in term of pre and post operative serum creatinine), there was no statistically significant difference between groups, were compared in acid base data (in term of post operative PH), there was no statistically significant difference between groups, were compared in weaning from ventilators (within 24 hours post operative) and there was no statistically significant difference between groups. Conclusion We concluded that in levosimendan group there was more significant increase in post operative TAPSI, in milrinone group there was more significant decrease of PAP and RVSP and in milrinone group there was increase in post operative AST/ALT.