Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Clinical study of hemodynamic profile, efficacy and safety of levosimendanin the treatment of syndrome of low cardiac output in neonatesand infants after cardiac surgery

Authors: L.A. Bockeria, G.V. Lobacheva, Z. Alymbek kyzy, A.F. Manerova, A.E. Khabarov

Company:
A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Ministry of Health of the Russia, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

Link: Clinical Physiology of Blood Circulaiton. 2015; (): -

Quote as: Bockeria L.A., Lobacheva G.V., Alymbek kyzy Z., Manerova A.F., Khabarov A.E.. Clinical study of hemodynamic profile, efficacy and safety of levosimendan in the treatment of syndrome of low cardiac output in neonates and infants after cardiac surgery. Klinicheskaya Fiziologiya Krovoobrashcheniya (Clinical Physiology of Circulation, Russian journal). 2015; 4: 5-14 (in Russ.)

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Abstract

Objective. Evaluate the efficacy, safety and influence of levosimendan on hemodynamics in newborns and children first year of life with acute heart failure after cardiac surgery.

Material and methods. In the present prospective study included 16 patients of the first year of life operated on for congenital heart disease in conditions of artificial blood circulation, in whom the postoperative period was complicated by development of the syndrome of low cardiac output refractory to infusions of catecholamines. The average age of the patients was 149.2 ± 82.3 per day, with 7 children (43.8 per cent) were operated in the neonatal period, and 4 patients (25.0%) are aged over 6 months. We included in the study patients were observed following anatomic variants of defects: transposition of the great arteries (n = 7; 43.7 per cent), total anomalous drainage of pulmonary veins (n = 2; 12.5%), common arterial trunk (n = 1; 6.3%), syndrome of hypoplasia of the left heart (n = 4; 25.0%) and single ventricle with hypoplasia aortic arch (n = 2; 12.5 per cent).

Results. All the children needed infusion of levosimendan about the low cardiac output refractory to catecholamines. Already 1 hour after the start of therapy were able to achieve statistically significant and persistent increases in systolic blood pressure from 54.0 to 71.6 ± 23.5 mm Hg (p < 0.05), reducing tachycardia with 169.0 ± 27.0 to 158.3 ± 22.6 beats/min (p < 0.05), reducing the pressure in the left atrium 13±2.4 to 10.0±2.7 mm Hg (p < 0.05) and reduction in temperature gradient from 8.7 ± 3.05 to 5.1 ± 2.7 °C (p < 0.01). Statistically significant (p < 0.05) for the first time there was an increase of diuresis after 24 hours of therapy and coincided with a reduction in central venous pressure from 17.0 ± 3.4 to 10.0 ± 2.8 mm Hg (p < 0.05) in children with hemodynamically single ventricle. All surviving patients, clinical improvement was accompanied by a reduction lactatemia from 4.0 to 2.2 mmol/l (p < 0.05) and the need for catecholamines (p < 0.001) 6 hours after the start of therapy and increased ejection fraction of the left ventricle on average by 10% in the first 6–12 hours of treatment (p < 0.05). Three children (18.8%) therapy levosimendan enabled the successful completion of cardiopulmonary bypass, and one patient is to stop circulation through the auxiliary 72 after surgery. Mortality was 18.8% (3/16).

Conclusion. Levosimendan allows you to stabilize the hemodynamics, reduce mortality and the incidence of multiple organ failure in children the first year of life with low cardiac output after cardiac surgery. Improvement in hemodynamics observed from the first hour of infusion, and the maximum effect is achieved after 24 hours.


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