Levosimendan Use Increases Cardiac Performance after Coronary Artery Bypass Grafting in End-Stage Renal Disease Patients

Authors

  • Hakan Atalay Department of Cardiovascular Surgery, Private Mersin Middle-East Hospital, Mersin
  • Zeki Temizturk Department of Cardiovascular Surgery, The Health Sciences Universtiy, Elazığ Research and Training Center, Elazığ
  • Hasan Baki Altinsoy Department of Radiology, The Health and Sciences University, Tunceli Government Hospital, Tunceli
  • Davut Azboy Department of Cardiovascular Surgery, The Health Sciences Universtiy, Elazığ Research and Training Center, Elazığ
  • Atakan Atalay Department of Cardiovascular Surgery, Çukurova University School of Medicine, Adana
  • Salih Colak Instructor of Cardiology, The Health Sciences University, Adana Numune Research and Training Center, Adana
  • Omer Faruk Dogan Department of Cardiovascular Surgery, The Health Sciences Universtiy, Numune Research and Training Center Adana

DOI:

https://doi.org/10.1532/hsf.1426

Abstract

Background: The effect of levosimendan on myocardial performance has not been studied in dialysis-dependent end-stage renal disease patients who have undergone coronary artery bypass grafting (CABG) surgery. Our aim was to investigate the effect of levosimendan on postoperative hemodynamic effects in end-stage renal disease patients undergoing CABG operation.
Methods: We performed 58 elective isolated CABG operations in end-stage renal disease patients. The study group received levosimendan at a slow bolus dose of 3 µg/kg, followed by a 24-hour infusion of 0.03-0.05 µg/kg/kg/min. (study group [SG]: n = 25). The remaining patients received a placebo (control group [CG]: n = 33). The mean left ventricular ejection fraction of both groups was similar (44.6 ± 55.4% versus 42.8 ± 53.9%). Hemodynamic data were collected at the end, at 1 hour after CPB, and thereafter at 6, 12, and 24 hours in the ICU. Preoperatively, at the end of the operation, at 1 hour after CPB, and thereafter at 6, 12, and 24 hours in the ICU, blood samples from the peripheral vein were collected for cardiac troponin-I (c-TnI) and lactate levels. Norepinephrine if needed started during the rewarming period in both groups.
Results: One patient in SG (4%) and 4 patients (12.1%) in CG died postoperatively (P < .01). Cardiac output and cardiac index values did not change early after weaning from extracorporeal circulation, and they were nearly similar during the next 6 hours in both groups. In SG, cardiac output and cardiac index significantly improved at 6 hours, and were stable at the end of 24 hours (P < .001). Hemodynamic parameters were nearly similar after the operation, and did not change significantly at the end of 24 hours in CG. Hemodynamic improvement caused a significant reduction in systemic and pulmonary artery vascular resistance index in SG (P < .002). Pulmonary capillary wedge pressure decreased significantly in SG (P < .034). Cumulative inotrope dose requirement and intraaortic balloon pump use were significantly lower in SG. In addition, blood lactate and cTnI levels were significanly lower in SG (P < .044).
Conclusion: No important adverse effect was detected during levosimendan infusion. Because levosimendan at a dose of 0.03-0.05 μg/kg/min increased myocardial performance significantly in the postoperative period, it can be used safely in end-stage renal disease patients undergoing isolated CABG. The requirement of vasopressors were lower in SG.

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Published

2016-10-27

How to Cite

Atalay, H., Temizturk, Z., Altinsoy, H. B., Azboy, D., Atalay, A., Colak, S., & Dogan, O. F. (2016). Levosimendan Use Increases Cardiac Performance after Coronary Artery Bypass Grafting in End-Stage Renal Disease Patients. The Heart Surgery Forum, 19(5), E230-E236. https://doi.org/10.1532/hsf.1426

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