OBJECTIVE: To evaluate the effects of 2 different administration modalities of levosimendan (start before cardiopulmonary bypass [CPB] and at the end of CPB) compared with a standard treatment with milrinone started at the end of CPB in cardiac surgery patients with a preoperative ejection fraction <30%. DESIGN: A prospective study. SETTING: A university hospital. PARTICIPANTS: Sixty patients undergoing elective cardiac surgery with CPB. INTERVENTIONS: Patients were randomly assigned to 3 different treatment options for weaning from CPB after cardiac surgery. Group A received milrinone, 0.5 microg/kg/min, after the release of the aortic cross-clamp; group B received levosimendan, 0.1 microg/kg/min, after the induction of anesthesia; and in group C, levosimendan, 0.1 microg/kg/min, was started immediately after the release of the aortic cross-clamp. In all patients, additional dobutamine, 5 microg/kg/min, was initiated after the release of the aortic cross-clamp. Norepinephrine maintained mean arterial pressure constant. MEASUREMENTS AND MAIN RESULTS:Stroke volume after surgery was initially higher than at baseline in all groups and highest in group B. Stroke volume declined 12 hours after surgery in group A but not in groups B and C (p < 0.05 between groups), despite similar filling pressures. Four patients in group A, none in group B, and 1 in group C died within 30 days of surgery. Postoperative atrial fibrillation was observed in 10 patients in group A, 7 patients in group C, and only 1 in group B (p < 0.01). No differences were observed in postoperative troponin I release among groups. CONCLUSION: In the conditions of the present study, starting the levosimendan treatment before CPB was associated with a higher initial postoperative stroke volume and a lower incidence of postoperative atrial fibrillation, but had no effect on the extent of postoperative troponin I release.
RCT Entities:
OBJECTIVE: To evaluate the effects of 2 different administration modalities of levosimendan (start before cardiopulmonary bypass [CPB] and at the end of CPB) compared with a standard treatment with milrinone started at the end of CPB in cardiac surgery patients with a preoperative ejection fraction <30%. DESIGN: A prospective study. SETTING: A university hospital. PARTICIPANTS: Sixty patients undergoing elective cardiac surgery with CPB. INTERVENTIONS:Patients were randomly assigned to 3 different treatment options for weaning from CPB after cardiac surgery. Group A received milrinone, 0.5 microg/kg/min, after the release of the aortic cross-clamp; group B received levosimendan, 0.1 microg/kg/min, after the induction of anesthesia; and in group C, levosimendan, 0.1 microg/kg/min, was started immediately after the release of the aortic cross-clamp. In all patients, additional dobutamine, 5 microg/kg/min, was initiated after the release of the aortic cross-clamp. Norepinephrine maintained mean arterial pressure constant. MEASUREMENTS AND MAIN RESULTS:Stroke volume after surgery was initially higher than at baseline in all groups and highest in group B. Stroke volume declined 12 hours after surgery in group A but not in groups B and C (p < 0.05 between groups), despite similar filling pressures. Four patients in group A, none in group B, and 1 in group C died within 30 days of surgery. Postoperative atrial fibrillation was observed in 10 patients in group A, 7 patients in group C, and only 1 in group B (p < 0.01). No differences were observed in postoperative troponin I release among groups. CONCLUSION: In the conditions of the present study, starting the levosimendan treatment before CPB was associated with a higher initial postoperative stroke volume and a lower incidence of postoperative atrial fibrillation, but had no effect on the extent of postoperative troponin I release.
Authors: Alexandre Mebazaa; Antonis A Pitsis; Alain Rudiger; Wolfgang Toller; Dan Longrois; Sven-Erik Ricksten; Ilona Bobek; Stefan De Hert; Georg Wieselthaler; Uwe Schirmer; Ludwig K von Segesser; Michael Sander; Don Poldermans; Marco Ranucci; Peter C J Karpati; Patrick Wouters; Manfred Seeberger; Edith R Schmid; Walter Weder; Ferenc Follath Journal: Crit Care Date: 2010-04-28 Impact factor: 9.097
Authors: M Carl; A Alms; J Braun; A Dongas; J Erb; A Goetz; M Goepfert; W Gogarten; J Grosse; A R Heller; M Heringlake; M Kastrup; A Kroener; S A Loer; G Marggraf; A Markewitz; D Reuter; D V Schmitt; U Schirmer; C Wiesenack; B Zwissler; C Spies Journal: Ger Med Sci Date: 2010-06-15
Authors: J Fassl; H Riha; H Ramakrishna; N Singh; T Wyckoff; C Roscher; J G T Augoustides Journal: HSR Proc Intensive Care Cardiovasc Anesth Date: 2010