Individualisierter Einsatz von Levosimendan in der Herzchirurgie

Woehrle, T.; Mehringer, L.; Juchem, G.; Dashkevich, A.; Weis, M.; Schünemann, M. und Kilger, E. (2020): Individualisierter Einsatz von Levosimendan in der Herzchirurgie. In: Anaesthesist, Bd. 70, Nr. 3: S. 204-212

Abstract

Background: Levosimendan is a cardiac inotrope that augments myocardial contractility without increasing myocyte oxygen consumption. Additionally, levosimendan has been shown to exhibit anti-inflammatory, antioxidative, and other cardioprotective properties and is approved for treatment of heart failure. Recent studies indicated that these beneficial effects can be achieved with doses lower than the standard dose of 12.5mg. Patients with preoperatively diagnosed left ventricular ejection fraction (LVEF) <= 40% received 1.25mg levosimendan after induction of anesthesia. After surgery, administration of low-dose levosimendan was repeated until cardiovascular stability was achieved. Objective: This study aimed to evaluate if pharmacological preconditioning with 1.25mg levosimendan in patients with LVEF <= 40% altered the postoperative need for inotropic agents, the incidence of newly occurring atrial fibrillation, renal replacement therapy, mechanical circulatory support and 30-day mortality. The cumulative dosage of levosimendan was recorded to assess the required dosage in the context of individualized treatment. Material and methods: This retrospective study included patients with preoperatively diagnosed LVEF <= 40% who underwent cardiac surgery at this institution between January 2015 and December 2018 and who received 1.25mg levosimendan after induction of anesthesia to prevent postoperative low cardiac output syndrome. Based on echocardiography results, invasive hemodynamic monitoring, and central venous or mixed venous oxygen saturation and lactate clearance, repetitive doses of levosimendan in 1.25mg increments could be postoperatively administered until cardiovascular stability was achieved. The results were compared to the current literature. Results: We identified 183 patients with LVEF <40% who received pharmacological preconditioning with 1.25mg levosimendan. Maximum doses of epinephrine, incidence of atrial fibrillation, need for renal replacement therapy and 30-day mortality were found to be below the published rates of comparable patient collectives. In 73.2% of patients, a cumulative dosage of 5mg levosimendan or less was considered sufficient. Conclusion The presented concept of pharmacological preconditioning with 1.25mg levosimendan followed by individualized additional dosing in cardiac surgery patients with preoperative LVEF <= 40% suggests that this concept is safe, with possible advantages regarding the need of inotropic agents, renal replacement therapy, and 30-day mortality, compared to the current literature. Individualized treatment with levosimendan to support hemodynamics and a timely reduction of inotropic agents needs further confirmation in randomized trials.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0003-2417
• Sprache: Deutsch