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January 1, 2024Journal of Cardiovascular Pharmacology and TherapeuticsOpen Access

Boosting the Beat: A Critical Showdown of Levosimendan and Milrinone in Surgical and Non-Surgical Scenarios: A Narrative Review

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Why the study?

To review the current indications and evidence for levosimendan and milrinone across various clinical scenarios, including acute heart failure, advanced cardiac failure, cardiac surgery, and sepsis.

Does levosimendan improve hemodynamic outcomes and mortality compared to milrinone in patients with heart failure, cardiac surgery, or sepsis?

Comparison

Levosimendan vs milrinone

Design

Narrative review

Key result

Levosimendan appears superior to milrinone for hemodynamic favorability in cardiac surgery and is linked to lower mortality than placebo in septic shock.

Authors

AQAlejandro Quintero-AltareCFCatalina Flórez-NavasHRHenry Robayo-Amórtegui

Discussion

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Member takes

Overview

May favor levosimendan in postoperative hemodynamics; hypothesis-generating for septic shock mortality pending RCTs.

Structured PICO

Does levosimendan improve hemodynamic outcomes and mortality compared to milrinone in patients with heart failure, cardiac surgery, or sepsis?

P
Population
Patients with acute heart failure, advanced cardiac failure, cardiac surgery, and sepsis
I
Intervention
Levosimendan
C
Comparator
Milrinone, dobutamine, or placebo
O
Outcome
Hemodynamic outcomes, mortality, intensive care unit stay, hospital stay, and mechanical ventilation time

This narrative review suggests levosimendan may offer superior hemodynamic benefits over milrinone in cardiac surgery and lower mortality than placebo in septic shock, though further research is needed.

Limitations

  • Differences exist between the populations assigned to each intervention in congenital heart disease studies
  • Additional research is necessary to further understand its impact on hemodynamic outcomes, mortality, and hospital stays in cardiogenic and septic shock
  • Differences exist between the populations assigned to each intervention
  • Additional research is necessary to further understand its impact

Cite This Study

Quintero-Altare et al. (2024) conducted a review in Acute heart failure, advanced cardiac failure, cardiac surgery, and sepsis. Levosimendan vs. Milrinone, dobutamine, or placebo was evaluated. Levosimendan appears superior to milrinone for hemodynamic favorability in cardiac surgery and is linked to lower mortality than placebo in septic shock.

synapsesocial.com/papers/6a07e28d416812afca06e592https://doi.org/10.1177/10742484241276431
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