INFLUENCE OF LEVOSIMENDAN ON THE INDICATORS OF CENTRAL HEMODYNAMICS IN PATIENTS WITH LOW CARDIAC OUTPUT SYNDROME THAT UNDERWENT CARDIOPULMONARY BYPASS FOR CARDIAC SURGERY
Keywords:
Levosimendan, cardiopulmonary bypass, central hemodynamics, cardiac surgeryAbstract
Postoperative low cardiac output syndrome (LCOS) is the most threatening and dramatic complication in patients that underwent cardiac surgery. The postoperative LCOS is a multifactorial problem. Its causes include initial patient’s state, the procedure of cardiopulmonary bypass itself, and the quality of both surgical techniques and anesthesiological care. The management of LCOS includes both pharmacological therapy (diuretics, venous dilators, inotropes) and mechanical support (intra-aortic balloon counterpulsation and ECMO). The aim of the study was to evaluate the influence on Levosimendan on hemodynamics of such patients. 45 patients were analyzed. They were initially treated with dobutamine, dopamine and norepinephrine. As far as the desired stabilization of hemodynamics was not achieved, the authors added Levosimendan to treatment options of these patients and performed the calculations of central hemodynamics indicators. The results were the increase of cardiac index in the evaluated patients, and the general improvement of hemodynamics indicators and tissue oxygen distribution. As a conclusion, authors state that Levosimendan is beneficial and leads to the overall improvement in the patients that underwent cardiopulmonary bypass for cardiac surgery in case of insufficient ‘triple’ management scheme with dobutamine, dopamine and norepinephrine.
References
Hensley F. A. Jr. A Practical Approach to Cardiac Anesthesia, 5th edn / F. A. Jr. Hensley, D. E. Martin & G. P. Gravlee, eds. – Philadelphia, PA : Lippincott, Williams and Wilkins, 2013. – P. 587–647.
Острая сердечная недостаточность. Европейский консенсус / Н. Т. Ватутин, А. Н. Шевелек, В. С. Колесников [и др.] // Архив внутренней медицины. – 2015. – № 4 (24). – C. 1–9.
Recommendations on prehospital & hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine / A. Mebazaa, M. B. Yilmaz, P. Levy [et al.] // Eur. Heart J. – 2015. – P. 544–558.
Маянская С. Д. Положительные инотропные средства для лечения острой сердечной недостаточности / С. Д. Маянская // Вестник современной клинической медицины. – 2013. – Вып. № 4, т. 6. – С. 79–85.
Crisis Management in Anesthesiology, Second Edition / David M. Gaba, Kevin J. Fish, Steven K. Howard, Amanda Burden // Elsevier. – 2014. – P. 314–317.
Cardiopulmonary Bypass and Mechanical Support, PRINCIPLES AND PRACTICE, 4 edition / Glenn P. Gravlee, Richard F. Davis, John Hammon, Barry Kussman. – Wolters Kluwer. – 2015. – P.136–219.
Kaplan Joel A. Kaplan’s Cardiac Anesthesia: The Echo Era, 6th еdition / Joel A. Kaplan, David L. Reich, Joseph S. Savino // Elsevier. – 2011. – P. 802–886.
Levosimendan: Molecular mechanisms and clinical implications. Consensus of experts on the mechanisms of action of levosimendan / Zoltán Papp, István Édes, Sonja Fruhwald [et al.] // International Journal of Cardiology. – 2012. – Vol. 159. – P.82–87.
