PMID- 19520657
OWN - NLM
STAT- MEDLINE
DCOM- 20090929
LR  - 20181201
IS  - 1308-0032 (Electronic)
IS  - 1302-8723 (Linking)
VI  - 9
IP  - 3
DP  - 2009 Jun
TI  - Timing of levosimendan in cardiac surgery.
PG  - 223-30
AB  - OBJECTIVE: Levosimendan (LS) is a new inodilator agent that improves cardiac 
      contractility by increasing the sensitivity of troponin C to calcium, which usage 
      in cardiac surgery has been growing in the recent years. We aimed to determine 
      the best timing of the administration of LS in high-risk patients who underwent 
      cardiovascular surgery. METHODS: Fifteen patients were evaluated retrospectively 
      who have left ventricular dysfunction, underwent open-heart surgery and were 
      applied LS in different phases of operation. Patients were divided into 3 groups 
      according to timing of LS. Levosimendan infusion (0. 1 microg-1kg-1min) was 
      applied after the induction of anaesthesia (n=5) (Group 1), during the pump 
      removal period (n=5) (Group 2) and in postoperative period (n=5) (Group 3). 
      Demographic data, operative characteristics, mean arterial pressure (MAP), mean 
      pulmonary arterial pressure (MPAP), pulmonary wedge capillary pressure (PWCP), 
      cardiac index (CI), inotropic agent consumption, postoperative urine output, 
      lactate levels of groups were compared between before and after LS treatment. 
      Data were evaluated by Fisher exact, Kruskal-Wallis, Mann-Whitney U and Wilcoxon 
      rank tests. RESULTS: In all patients, urine output was satisfactory 24 hours 
      after LS application. There was a significant increase in CI of all 3 groups 
      (p=0.04). Also, there was a significant decrease in PCWP of all 3 groups before 
      and after LS (p=0.04). There was a significant decrease in MPAP in Group 2 and 3 
      (p=0.04). Twenty- four hours after LS application, whereas all inotropic agents 
      could be stopped in Group 1 and 2, in Group 3 inotropic infusion (dopamine [10 
      microg-1kg-1min (5-17.5)], dobutamine [15 microg-1kg-1min (5-20)] and adrenaline 
      [0.4 microg-1kg-1min (0.15-0.65)]) couldn't be stopped (p=0.007). During 
      postoperative period, in Groups 1 and 2 one case from each required intraaortic 
      balloon pump, while in Group 3 four patients were applied intraaortic balloon 
      pump (p=0.08). CONCLUSION: According to our experience, LS is effective in 
      high-risk cases during cardiac surgery, especially during the intra-operative and 
      pump removal periods;however, no successful outcomes were observed during the 
      post-operative period. As a result, case selection and timing should be performed 
      well when using LS.
FAU - Aksun, Murat
AU  - Aksun M
AD  - From II. Clinic of Anesthesiology and Reanimation, Izmir Ataturk Training and 
      Research Hospital, Izmir, Turkey. murataksun@yahoo.com
FAU - Karahan, Nagihan
AU  - Karahan N
FAU - Adanir, Tayfun
AU  - Adanir T
FAU - Aran, Gulcin
AU  - Aran G
FAU - Yetkin, Ufuk
AU  - Yetkin U
FAU - Ozturk, Tulin
AU  - Ozturk T
FAU - Sencan, Atilla
AU  - Sencan A
FAU - Ozgurbuz, Ugur
AU  - Ozgurbuz U
FAU - Gurbuz, Ali
AU  - Gurbuz A
LA  - eng
PT  - Journal Article
PL  - Turkey
TA  - Anadolu Kardiyol Derg
JT  - Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology
JID - 101095069
RN  - 0 (Cardiotonic Agents)
RN  - 0 (Hydrazones)
RN  - 0 (Pyridazines)
RN  - 349552KRHK (Simendan)
SB  - IM
MH  - Aged
MH  - Cardiac Output, Low/*drug therapy
MH  - Cardiotonic Agents/*administration & dosage
MH  - Drug Administration Schedule
MH  - Female
MH  - Hemodynamics/drug effects
MH  - Humans
MH  - Hydrazones/*administration & dosage
MH  - Intraoperative Care
MH  - Male
MH  - Middle Aged
MH  - Myocardial Contraction/drug effects
MH  - Patient Selection
MH  - Postoperative Care
MH  - Pyridazines/*administration & dosage
MH  - Retrospective Studies
MH  - Simendan
MH  - Time Factors
MH  - Ventricular Dysfunction, Left/*surgery
EDAT- 2009/06/13 09:00
MHDA- 2009/09/30 06:00
CRDT- 2009/06/13 09:00
PHST- 2009/06/13 09:00 [entrez]
PHST- 2009/06/13 09:00 [pubmed]
PHST- 2009/09/30 06:00 [medline]
PST - ppublish
SO  - Anadolu Kardiyol Derg. 2009 Jun;9(3):223-30.