Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

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


Issue's catalogue ➤ Клиническая физиология кровообращения, 2015, №4 ➤ Клиническое исследование гемодинамического профиля, эффективности и безопасности левосимендана в лечении синдрома низкого сердечного выброса у новорожденных и детей первого года жизни после кардиохирургических вмешательств

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.)

Keywords:  syndrome of low cardiac output children newborns levosimendan congenital heart diseases artificial circulation

Full text:  

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.

References

  1. Бокерия Л.А., Лобачева Г.В., Ярустовский М.Б., Харькин А.В., Григорьянц Р.Г. Новые возможности интенсивной терапии синдрома полиорганной недостаточности у новорожденных после кардиохирургических вмешательств. Детские болезни сердца и сосудов. 2005; 3: 39–44.
  2. Levin R.L., Degrange M.A., Porcile R., Salvagio F., Blanco N., Botbol L.A. The preoperative utilization of levosimendan (preoperative optimization) reduced mortality and low output syndrome after cardiac surgery in patients with low ejection fraction (EF<25%). Circulation. 2007; 116: 682.
  3. Харькин А.В. Комплексная интенсивная терапия у новорожденных после кардиохирургических вмешательств. Дис. … д-ра мед. наук. М.; 2008.
  4. Ibsen L. Perioperative management of patients with congenital heart disease: a multidisciplinary approach. In: Nichols D.G. (ed.) Critical heart disease in infants and children. 2006. Philadelphia: Mosby Elsevier: 561–79.
  5. Papp Z., Csapó K., Pollesello P., Haikala H., Edes I. Pharmacological mechanisms contributing to the clinical efficacy of levosimendan. Cardiovasc. Drug. Rev. 2005; 23: 71–98.
  6. De Hert S.G., Lorsomradee S., Van den Eede H., Cromheecke S., Van der Linden P.J. A randomized trial evaluating different modalities of levosimendan administration in cardiac surgery patients with myocardial dysfunction. J. Cardiothorac. Vasc. Anesth. 2008; 22: 699–705.
  7. Harjola V., Siirilä K., Suojaranta-Ylinen R. Levosimendan in cardiac surgery. Crit. Care. 2004; 8 (Suppl. 1): 85.
  8. Jörgensen K., Bech-Hanssen O., Houltz E., Ricksten S.E. Effects of Levosimendan on left ventricular relaxation and early filling at maintained preload and afterload conditions after aortic valve replacement for aortic stenosis. Circulation. 2008; 117 (8): 1075–81.
  9. Lehmann A., Boldt J., Lang J., Isgro F., Blome M. Is levosimendan an inoprotective drug in patients with acute coronary syndrome undergoing surgical revascularization? Anasthesiol. Intensivmed Notfallmed Schmerzther. 2003; 38: 577–82.
  10. Lehmann A., Lang J., Boldt J., Isgro F., Kiessling A.H. Levosimendan in patients with cardiogenic shock undergoing surgical revascularization. A case series. Med. Sci. Monit. 2004; 10: 89–93.
  11. Nijhawan N., Nicolosi A.C., Montgomery M.W., Aggarwal A., Pagel P.S., Warltier D.C. Levosimendan enhances cardiac performance after cardiopulmonary bypass: a prospective, randomized placebo-controlled trial. J. Cardiovasc. Pharmacol. 1999; 34: 219–28.
  12. Sandell E.P., Nijhawan N., Pagel P.S., Warltier D.C. Levosimendan enhances cardiac performance in patients following cardiac surgery and cardiopulmonary bypass. Crit. Care. 2002; 6 (Suppl. 1): 142.
  13. Tasouli A., Papadopoulos K., Antoniou T., Kriaras I., Stavridis G., Degiannis D., Geroulanos S. Efficacy and safety of perioperative infusion of levosimendan in patients with compromised cardiac function undergoing open-heart surgery: importance of early use. Eur. J. Cardio-Thorac. Surg. 2007; 32: 629–33.
  14. Topjian A.A., Berg A.R., Nadkarni V.M. Pediatric cardiopulmonary resuscitation: advances in science, techniques, and outcomes. Pediatrics. 2008; 122: 1086–98.
  15. Tritapepe L., De Santis V., Vitale D., Guarracino F., Pellegrini F., Pietropaoli P., Singer M. Levosimendan pre-treatment improves outcomes in patients undergoing coronary artery bypass graft surgery. BJA. 2008; 102: 198–204.
  16. Turanlahti M., Boldt T., Palkama T., Antila S., Lehtonen L., Pesonen E. Pharmacokinetics of levosimendan in pediatric patients evaluated for cardiac surgery. Pediatr. Crit. Care Med. 2004; 5: 457–62.
  17. Rajek A.M., Koinig H., Jelen M., Schiferer A., Hutschala D. Levosimendan, a new Ca-sensitizer, in patients with poor left ventricular function undergoing cardiac surgery. Anesthesiology. 2003; 99: 133.
  18. Лобачева Г.В., Харькин А.В., Манерова А.Ф., Джобава Э.Р. Интенсивная терапия новорожденных и детей первого года жизни с острой сердечной недостаточностью после кардиохирургических вмешательств. Анестезиология и реаниматология. 2010; 5: 23–7.
  19. Braun J.P., Schneider M., Kastrup M., Liu J. Treatment of acute heart failure in an infant after cardiac surgery using levosimendan. Eur. J. Cardio-Thorac. Surg. 2004; 26: 228–30.
  20. Egan J.R., Clarke A.J., Williams S., Cole A.D., Ayer J., Jacobe S., Chard R.B., Winlaw D.S. Levosimendan for low cardiac output: a pediatric experience. J. Intensive Care Med. 2006; 21: 183–7.
  21. Garisto C., Favia I., Ricci Z., Chiara L.D., Morelli S., Giorni C., Vitale V., Picardo S., Di Donato R.M. Initial single-center experience with levosimendan infusion for perioperative management of univentricular heart with ductal-dependent systemic circulation. World J. Pediatr. Congenital Heart Surg. 2010; 1: 292–9.
  22. Барбухатти К.О., Борисков М.В., Скопец А.А., Шелестова И.А., Молчанова Н.В., Пересада С.П. Первый опыт лечения острой сердечной недостаточности у новорожденного после кардиохирургической операции с использованием левосимендана (≪Симдакс≫ фирмы ≪Orion pharma≫). Патология кровообращения и кардиохирургия. 2004; 3: 75–6.
  23. Namachivayam P., Crossland D.S., Butt W.W., Shekerdemian L.S. Early experience with levosimendan in children with ventricular dysfunction. Pediatr. Crit. Care Med. 2006; 7: 445–8.
  24. Boni L., García E., Galletti L., Pérez A., Herrera D., Ramos V. et al. Current strategies in tetralogy of Fallot repair: pulmonary valve sparing and evolution of right ventricle/left ventricle pressures ratio. Eur. J. Cardio- Thorac. Surg. 2009; 35: 885–90.

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