Key result
Prophylactic levosimendan improves postoperative hemodynamics by preserving LVEF and lowering PAP.
Why the study?
The study evaluated the perioperative hemodynamic effects and short-term clinical outcomes of prophylactic levosimendan infusion in high-risk mitral valve surgery patients with left ventricular dysfunction.
Does prophylactic levosimendan infusion improve perioperative hemodynamics in patients with left ventricular dysfunction and pulmonary hypertension undergoing high-risk mitral valve surgery?
RCT (n=100)
randomized
Does prophylactic levosimendan infusion improve perioperative hemodynamics in patients with left ventricular dysfunction and pulmonary hypertension undergoing high-risk mitral valve surgery?
p-value: p=<0.001
Prophylactic levosimendan infusion improves perioperative hemodynamics and preserves left ventricular systolic performance in high-risk patients undergoing mitral valve surgery.
Supports prophylactic levosimendan in high-risk mitral valve surgery; extends mixed prior evidence for LV dysfunction with pulmonary hypertension.
Background: Levosimendan has anti-ischemic effects, improves myocardial contractility and increases systemic, pulmonary and coronary vasodilatation. Objectives: The present study investigated the perioperative hemodynamic effects of a prophylactic infusion of levosimendan in high-risk mitral valve surgery patients with left ventricle dysfunction, and compared short-term clinical outcomes with a control group in which levosimendan wasn’t used. Patients and methods: BetweenOctober 2019 and May 2021, a prospective randomized clinical study was performed in 100 patients with high-risk mitral valve surgery with left ventricular dysfunction and pulmonary hypertension. In the study group, patients received levosimendan infusion at a dose of 0.1 mcg/kg/min after the induction of anesthesia while in control group levosimendan was not used. The intraoperative and postoperative data were recorded for each patient in both groups. The hemodynamic measurements were performed at six predetermined time points (0, 1, 6, 12, 24 and 36 hours postoperatively). Results: Levosimendan had significantly improved postoperative hemodynamic values. It improved mean arterial pressure at different times postoperatively (p < 0.05), heart rate at different times postoperatively (p < 0.05). Also, levosimendan preserved LV systolic performance postoperatively (pulmonary artery pressure (PAP): 51.7 ± 6.4, 57.9 ± 8.6, P<0.001) and (ejection fraction (EF): 37.1 ± 9.3, 33.4 ± 7.1, P=0.03). Conclusion: Prophylactic levosimendan improved the hemodynamics in high-risk mitral valve surgery patients. So levosimendan seems to be a safe and effective choice for preventing left ventricular failure in high-risk mitral valve surgical patients with LV dysfunction.
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Elwakeel et al. (2022) conducted an RCT in High-risk mitral valve surgery with left ventricular dysfunction and pulmonary hypertension (n=100). Levosimendan vs. No levosimendan was evaluated on Perioperative hemodynamic effects (pulmonary artery pressure and ejection fraction) (p=<0.001). Prophylactic levosimendan infusion improved postoperative hemodynamics, preserving left ventricular ejection fraction (37.1 vs 33.4, P=0.03) and pulmonary artery pressure (51.7 vs 57.9, P<0.001).
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