Alberto Zangrillo1, Gabriele Alvaro2, Alessandro Belletti3, Antonio Pisano4, Luca Brazzi5, Maria G Calabrò6, Fabio Guarracino7, Tiziana Bove6, Evgeny V Grigoryev8, Fabrizio Monaco6, Vladimir A Boboshko9, Valery V Likhvantsev10, Anna M Scandroglio6, Gianluca Paternoster11, Rosalba Lembo6, Samuele Frassoni6, Marco Comis12, Vadim V Pasyuga13, Paolo Navalesi14, Vladimir V Lomivorotov9. 1. Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. 2. Department of Anesthesia and Intensive Care, AOU Mater Domini Germaneto, Catanzaro, Italy. 3. Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy. Electronic address: belletti.ale@gmail.com. 4. Division of Cardiac Anesthesia and Intensive Care Unit, AORN dei Colli - Monaldi Hospital, Naples, Italy. 5. Department of Anesthesia and Intensive Care, AOU Città della Salute e della Scienza, Turin, Italy; Department of Surgical Sciences, University of Turin, Turin, Italy. 6. Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy. 7. Division of Cardiothoracic Anesthesia and Intensive Care, Department of Anesthesia and Critical Care Medicine, AOU Pisana, Pisa, Italy. 8. Department of Anesthesiology and Intensive Care, State Research Institute for Complex Issues of Cardiovascular Disease, Kemerovo, Russia. 9. Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia. 10. Department of Anesthesiology and Intensive Care, Moscow Regional Clinical and Research Institute, Moscow, Russia. 11. Department of Anesthesia and Intensive Care, San Carlo Hospital, Potenza, Italy. 12. Department of Cardiovascular Anesthesia and Intensive Care, AO Ordine Mauriziano, Turin, Italy. 13. Department of Anesthesiology and Intensive Care, Federal Center for Cardiovascular Surgery Astrakhan, Astrakhan, Russia. 14. Department of Anesthesia and Intensive Care, AOU Mater Domini Germaneto, Catanzaro, Italy; Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
Abstract
OBJECTIVE:Acute kidney injury (AKI) occurs frequently after cardiac surgery. Levosimendan might reduce the incidence of AKI in patients undergoing cardiac surgery. The authors investigated whether levosimendan administration could reduce AKI incidence in a high-risk cardiac surgical population. DESIGN: Post hoc analysis of a multicenter randomized trial. SETTING:Cardiac surgery operating rooms and intensive care units of 14 centers in 3 countries. PARTICIPANTS: The study comprised 90 patients who underwent mitral valve surgery with an estimated glomerular filtration rate <60 mL/min/1.73 m2 and perioperative myocardial dysfunction. INTERVENTIONS: Patients were assigned randomly to receive levosimendan (0.025-0.2 μg/kg/min) or placebo in addition to standard inotropic treatment. MEASUREMENTS AND MAIN RESULTS:Forty-six patients were assigned to receive levosimendan and 44 to receive placebo. Postoperative AKI occurred in 14 (30%) patients in the levosimendan group versus 23 (52%) in the placebo group (absolute difference -21.8; 95% confidence interval -41.7 to -1.97; p = 0.035). The incidence of major complications also was lower (18 [39%]) in the levosimendan group versus that in the placebo group (29 [66%]) (absolute difference -26.8 [-46.7 to -6.90]; p = 0.011). A trend toward lower serum creatinine at intensive care unit discharge was observed in the levosimendan group (1.18 [0.99-1.49] mg/dL) versus that in the placebo group (1.39 [1.05-1.76] mg/dL) (95% confidence interval -0.23 [-0.49 to 0.01]; p = 0.07). CONCLUSIONS:Levosimendan may improve renal outcome in cardiac surgery patients with chronic kidney disease undergoing mitral valve surgery who develop perioperative myocardial dysfunction. Results of this exploratory analysis should be investigated in future properly designed randomized controlled trials.
RCT Entities:
OBJECTIVE:Acute kidney injury (AKI) occurs frequently after cardiac surgery. Levosimendan might reduce the incidence of AKI in patients undergoing cardiac surgery. The authors investigated whether levosimendan administration could reduce AKI incidence in a high-risk cardiac surgical population. DESIGN: Post hoc analysis of a multicenter randomized trial. SETTING: Cardiac surgery operating rooms and intensive care units of 14 centers in 3 countries. PARTICIPANTS: The study comprised 90 patients who underwent mitral valve surgery with an estimated glomerular filtration rate <60 mL/min/1.73 m2 and perioperative myocardial dysfunction. INTERVENTIONS:Patients were assigned randomly to receive levosimendan (0.025-0.2 μg/kg/min) or placebo in addition to standard inotropic treatment. MEASUREMENTS AND MAIN RESULTS: Forty-six patients were assigned to receive levosimendan and 44 to receive placebo. Postoperative AKI occurred in 14 (30%) patients in the levosimendan group versus 23 (52%) in the placebo group (absolute difference -21.8; 95% confidence interval -41.7 to -1.97; p = 0.035). The incidence of major complications also was lower (18 [39%]) in the levosimendan group versus that in the placebo group (29 [66%]) (absolute difference -26.8 [-46.7 to -6.90]; p = 0.011). A trend toward lower serum creatinine at intensive care unit discharge was observed in the levosimendan group (1.18 [0.99-1.49] mg/dL) versus that in the placebo group (1.39 [1.05-1.76] mg/dL) (95% confidence interval -0.23 [-0.49 to 0.01]; p = 0.07). CONCLUSIONS:Levosimendan may improve renal outcome in cardiac surgery patients with chronic kidney disease undergoing mitral valve surgery who develop perioperative myocardial dysfunction. Results of this exploratory analysis should be investigated in future properly designed randomized controlled trials.
Authors: Jose L Guerrero-Orriach; Alfredo Malo-Manso; Marta Ramirez-Aliaga; Ana Isabel Florez Vela; Manuel Galán-Ortega; Isabel Moreno-Cortes; Inmaculada Gonzalez-Almendros; Alicia Ramirez-Fernandez; Daniel Ariza-Villanueva; Juan Jose Escalona-Belmonte; Guillermo Quesada-Muñoz; Enrique Sepúlveda-Haro; Salvador Romero-Molina; Inmaculada Bellido-Estevez; Aurelio Gomez-Luque; Manuel Rubio-Navarro; Juan Alcaide-Torres; Concepcion Santiago-Fernandez; Lourdes Garrido-Sanchez; Jose Cruz-Mañas Journal: Front Pharmacol Date: 2020-08-26 Impact factor: 5.810
Authors: Zoltán Papp; Piergiuseppe Agostoni; Julian Alvarez; Dominique Bettex; Stefan Bouchez; Dulce Brito; Vladimir Černý; Josep Comin-Colet; Marisa G Crespo-Leiro; Juan F Delgado; István Édes; Alexander A Eremenko; Dimitrios Farmakis; Francesco Fedele; Cândida Fonseca; Sonja Fruhwald; Massimo Girardis; Fabio Guarracino; Veli-Pekka Harjola; Matthias Heringlake; Antoine Herpain; Leo M A Heunks; Tryggve Husebye; Višnja Ivancan; Kristjan Karason; Sundeep Kaul; Matti Kivikko; Janek Kubica; Josep Masip; Simon Matskeplishvili; Alexandre Mebazaa; Markku S Nieminen; Fabrizio Oliva; Julius G Papp; John Parissis; Alexander Parkhomenko; Pentti Põder; Gerhard Pölzl; Alexander Reinecke; Sven-Erik Ricksten; Hynek Riha; Alain Rudiger; Toni Sarapohja; Robert H G Schwinger; Wolfgang Toller; Luigi Tritapepe; Carsten Tschöpe; Gerhard Wikström; Dirk von Lewinski; Bojan Vrtovec; Piero Pollesello Journal: J Cardiovasc Pharmacol Date: 2020-07 Impact factor: 3.105
Authors: Zoltán Papp; Piergiuseppe Agostoni; Julian Alvarez; Dominique Bettex; Stefan Bouchez; Dulce Brito; Vladimir Černý; Josep Comin-Colet; Marisa G Crespo-Leiro; Juan F Delgado; Istvan Édes; Alexander A Eremenko; Dimitrios Farmakis; Francesco Fedele; Cândida Fonseca; Sonja Fruhwald; Massimo Girardis; Fabio Guarracino; Veli-Pekka Harjola; Matthias Heringlake; Antoine Herpain; Leo Ma Heunks; Tryggve Husebye; Višnja Ivancan; Kristjan Karason; Sundeep Kaul; Matti Kivikko; Janek Kubica; Josep Masip; Simon Matskeplishvili; Alexandre Mebazaa; Markku S Nieminen; Fabrizio Oliva; Julius-Gyula Papp; John Parissis; Alexander Parkhomenko; Pentti Põder; Gerhard Pölzl; Alexander Reinecke; Sven-Erik Ricksten; Hynek Riha; Alain Rudiger; Toni Sarapohja; Robert Hg Schwinger; Wolfgang Toller; Luigi Tritapepe; Carsten Tschöpe; Gerhard Wikström; Dirk von Lewinski; Bojan Vrtovec; Piero Pollesello Journal: Card Fail Rev Date: 2020-07-08
Authors: Oliver K Jawitz; Amanda S Stebbins; Vignesh Raman; Brooke Alhanti; Sean van Diepen; Matthias Heringlake; Stephen Fremes; Richard Whitlock; Steven R Meyer; Rajendra H Mehta; Mark Stafford-Smith; Shaun G Goodman; John H Alexander; Renato D Lopes Journal: Am Heart J Date: 2020-10-28 Impact factor: 4.749