Key result
Levosimendan 0.1 μg/kg/min compared to dobutamine 5 μg/kg/min showed more vasodilation, lesser initial inotropic activity, and a significant increase in cardiac index >12 hours post-infusion.
Why the study?
Does levosimendan compared to dobutamine improve hemodynamic parameters in patients undergoing mitral valve surgery for severe mitral stenosis?
RCT (n=60)
Does levosimendan compared to dobutamine improve hemodynamic parameters in patients undergoing mitral valve surgery for severe mitral stenosis?
Levosimendan produces more vasodilation and less initial inotropic support than dobutamine during weaning from cardiopulmonary bypass in mitral stenosis surgery, often requiring additional vasopressors.
May require additional vasopressors despite delayed benefits; hypothesis-generating for levosimendan in mitral valve surgery, pending randomized trials.
AIMS AND OBJECTIVES: We aimed to compare the hemodynamic effects of levosimendan and dobutamine in patients undergoing mitral valve surgery on cardiopulmonary bypass (CPB). MATERIALS AND METHODS: Sixty patients were divided into 2 groups of 30 each. Group-L patients received levosimendan 0.1 μg/kg/min and Group-D patients received dobutamine 5 μg/kg/min while weaning off CPB. Additional inotrope and/or vasoconstrictor were started based on hemodynamic parameters. Hemodynamic data were collected at the end and at 30 minutes after CPB, thereafter at 6, 12, 24, and 36 hours post-CPB. Mean arterial pressure (MAP), central venous pressure (CVP), heart rate (HR), cardiac index (CI), systemic vascular resistance index (SVRI), and lactate levels were measured. RESULTS: Group-L showed increased requirement of inotropes and vasoconstrictors. The SVRI, CVP, and MAP were reduced more in Group-L. The CI was low in Group-L in the initial period when compared to Group-D. Later Group-L patients showed a statistically significant increase in CI even after 12 hrs of discontinuation of levosimendan infusion. The HR was increased more in Group-D. Lactate levels, intensive care unit stay, and duration of ventilation were similar in both groups. CONCLUSIONS: Levosimendan 0.1 μg/kg/min compared to dobutamine 5 μg/kg/min showed more vasodilation and lesser inotropic activity in patients undergoing mitral valve surgery for mitral stenosis. Levosimendan compared to dobutamine showed a statistically significant increase in CI even after 12 hrs of discontinuation. The requirement of another inotrope or vasopressor was frequent in levosimendan group.
No takes yet. Share an insight, caveat, or question.
Gandham et al. (2013) conducted an RCT in Severe mitral stenosis (n=60). Levosimendan vs. Dobutamine 5 μg/kg/min was evaluated on Hemodynamic parameters (MAP, CVP, HR, CI, SVRI, and lactate levels). Levosimendan 0.1 μg/kg/min compared to dobutamine 5 μg/kg/min showed more vasodilation, lesser initial inotropic activity, and a significant increase in cardiac index >12 hours post-infusion.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: