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Abstracts and Programme, EUROANAESTHESIA 2008: Intensive Care Medicine

Haemodinamic effects of levosimendan in patients with pulmonary hypertension after cardiac surgical procedures under extracorporeal circulation

12AP4-6

Amor, M.; Selas, S.; Fernandez, A.; Garea, M.; Alvarez, J.

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European Journal of Anaesthesiology (EJA): May-June 2008 - Volume 25 - Issue - p 174
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Background and Goal of Study: Levosimendan is an inotropic agent (calcium sensitizing agent) that is frequently used for the treatment of low cardiac output syndrome1. However, not much information about the use of this therapy in patients with pulmonary hypertension is available. This study intends to analyze the levosimendan effects above pulmonary circulation in pulmonary hypertension patients; all of them have required extracorporeal circulation for cardiac surgical procedures.

Materials and Methods: Thirty patients with preoperative MPAP>35mmHg and in the postoperative period they suffered a low cardiac output syndrome (CO (cardiac output)<2,2l/min/m2 and PCP>15mmHg). Fifteen of these patients have been treated with levosimendan 6μg/kg/min in bolus of 20 minutes and infusion 0,15 μg/kg/min for 24 hours (Group I). The others patients have been treated with dobutamina 7,5-15 μg/kg/min (Group II). Cardiac frequency (CF, throb/min); medium arterial pressure (MAP, mmHg); medium pulmonary arterial pressure (MPAP, mmHg); pulmonary capillary pressure (PCP, mmHg); central venous pressure (CVP; mmHg); cardiac index (CI, l/min/m2); systemic vascular resistances (SVR, dyn/seg/cm5); pulmonary vascular resistances (PVR, dyn/seg/cm5) have been revised in all patients before and after of therapy administration.

Results and Discussion: see table 1

Table 1
Table 1:
No Caption available.

Although both dobutamine and levosimendan improved the cardiac index, the increase was significantly greater with levosimendan. Levosimendan significantly reduced systemic and pulmonary vascular resistance, and significantly decreased systemic arterial, pulmonary arterial, pulmonary capillary wedge, and central venous pressure.

Conclusion(s): Levosimendan present a obvious increase of cardiac index more important than dobutamina and produce a vasodilator effect systemic as well as pulmonary larger than dobutamina. However, these results estimate that pulmonary vasodilatation is not selective.

References:

Álvarez J et al. Rev Esp Cardiol 2006, 59: 438—445.
© 2008 European Society of Anaesthesiology