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Intracoronary administration of levosimendan in patients with acute coronary syndromes and decreased left ventricular ejection fraction undergoing coronary artery bypass graft surgery

  • VJERA MARINOV1
  • NENAD KARANOVIC2
  • MLADEN CAREV2
  • CRISTIJAN BULAT3
  • DUBRAVKA KO CEN2
  • MIHAJLO LOJPUR2
  • ZDENKO COVIC2
  • BOZENA IVANCEV2
  • ZVONIMIR PARCINA2

1Anesthesiology Unit, Cito Clinic Split

2 Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital Split

3 Department of Cardiac Surgery, University Hospital Split

DOI: 10.22514/SV132.112017.3 Vol.13,Issue 2,November 2017 pp.25-28

Published: 06 November 2017

*Corresponding Author(s): MLADEN CAREV E-mail: mladen.carev1@gmail.com

Abstract

In cardiac surgery patients, intracoronary (IC) administration of levosimendan can provide optimal drug spread, enabling ef-fective manifestation of favorable drug effects and avoiding potentially harm-ful systemic hypotension. This could be beneficial in acute coronary syndromes (ACS) with decreased left ventricular ejec-tion fraction (LVEF). We present ten cases of IC administration of levosimendan in ACS manifested as ST segment elevation myocardial infarction, non-ST segment el-evation myocardial infarction or unstable angina pectoris. All patients underwent coronary artery bypass graft (CABG) sur-gery, performed as an “off-pump” or “on-pump”/“off-clamp” procedure (latter one with the use of cardiopulmonary bypass on the beating heart). Levosimendan was ad-ministered as an IC bolus (125-250 μg) in each coronary artery graft (2-3 grafts). In-travenous (IV) levosimendan infusion con-tinued (0.1-0.2 μg•kg-1•min-1) after graft placements (24-48 h), with IV infusion of norepinephrine (0.1 mg•ml-1), if needed. Cardiac function was assessed using LVEF (%) (Teicholz), thermodilution cardiac in-dex (CI) (ml•m-2), and systemic vascular resistance (SVR) (dynes•sec•cm-5). Nonparametric Wilcoxon signed-ranks test [presented as median (MED) with interquartile range (IQR)] indicated a sig-nificant difference between preoperative vs. immediate postoperative CI, SVR, and LVEF in all cases [2.2 (1.9-2.5) vs. 3.1 (2.9-3.4) ml•m-2, 1173.0 (1062.7-1278.2) vs. 882.5 (763.5-993.0) dynes•sec•cm-5, 44.5 (36.0-46.7) vs. 53.5 (45.7-59.2) %, respec-tively] (P=0.005), i.e. IC administration of levosimendan was associated with prompt improvement of intraoperative hemody-namics and cardiac contractility. IC ad-ministration of levosimendan may be a promising alternative method for improv-ing decreased cardiac function in acute cardiac ischemia, besides necessary surgi-cal revascularization.

Keywords

levosimendan, intracoronary, acute coronary syndromes, CABG surgery 

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VJERA MARINOV,NENAD KARANOVIC,MLADEN CAREV,CRISTIJAN BULAT,DUBRAVKA KO CEN,MIHAJLO LOJPUR,ZDENKO COVIC,BOZENA IVANCEV,ZVONIMIR PARCINA. Intracoronary administration of levosimendan in patients with acute coronary syndromes and decreased left ventricular ejection fraction undergoing coronary artery bypass graft surgery. Signa Vitae. 2017. 13(2);25-28.

References

1. Tritapepe L, De Santis V, Vitale D, Guarracino F, Pellegrini F, Pietropaoli P, et al. Levosimendan pre-treatment improves outcomes in patients undergoing coronary artery bypass graft surgery. Br J Anaesth 2009;102(2):198-204.

2. Parissis JT, Rafouli-Stergiou P, Stasinos V, Psarogiannakopoulos P, Mebazaa A. Inotropes in cardiac patients: update 2011. Curr Opin Crit Care 2010;16(5):432-41.

3. Mebazaa A, Pitsis AA, Rudiger A, Toller W, Longrois D, Ricksten SE, et al. Clinical review: Practical recommendations on the man-agement of perioperative heart failure in cardiac surgery. Crit Care 2010;14(2):201.

4. Toller W, Heringlake M, Guarracino F, Algotsson L, Alvarez J, Argyriadou H, et al. Preoperative and perioperative use of levosi-mendan in cardiac surgery: European expert opinion. Int J Cardiol 2015;184:323-36.

5. Pieske B. Levosimendan in regional myocardial ischemia. Cardiovasc Drugs Ther 2002;16(5):379-81.

6. Caimmi PP, Molinari C, Uberti F, Micalizzi E, Valente G, Mary DA, et al. Intracoronary levosimendan prevents myocardial is-chemic damages and activates survival signaling through ATP-sensitive potassium channel and nitric oxide. Eur J Cardiothorac Surg 2011;39(4):e59-67.

7. Malmberg M, Vähäsilta T, Saraste A, Koskenvuo JW, Pärkkä JP, Leino K, et al. Intracoronary levosimendan during ischemia prevents myocardial apoptosis. Front Physiol 2012;3:17.

8. Caimmi PP, Kapetanakis EI, Beggino C, Molinari C, Giustini G, Crosio E, et al. Management of acute cardiac failure by intracoronary administration of levosimendan. J Cardiovasc Pharmacol 2011;58(3):246-53.

9. Givertz MM, Andreou C, Conrad CH, Colucci WS. Direct myocardial effects of levosimendan in humans with left ventricular dys-function: alteration of force-frequency and relaxation-frequency relationships. Circulation 2007;115(10):1218-24.

10. Jamali IN, Kersten JR, Pagel PS, Hettrick DA, Warltier DC. Intracoronary levosimendan enhances contractile function of stunned myocardium. Anesth Analg 1997;85(1):23-9.

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