Preoperative and perioperative use of levosimendan in cardiac surgery: European expert opinion

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:184

Review

Toller, W.¹  Heringlake, M.²  Guarracino, F.³  Algotsson, L.⁴  Alvarez, J.⁵  Argyriadou, H.^6,7  Ben-Gal, T.⁸  Cerny, V.⁹  Cholley, B.^10,11  Eremenko, A.¹²  Guerrero-Orriach, J. L.¹³  Jarvela, K.^14,15  Karanovic, N.¹⁶  Kivikko, M.¹⁷  Lahtinen, P.¹⁸  Lomivorotov, V.¹⁹  Mehta, R. H.^20,21  Music, S.²²  Pollesello, P.¹⁷  Rex, S.²³  Riha, H.²⁴  Rudiger, A.²⁵  Salmenpera, M.²⁶  Szudi, L.²⁷  Tritapepe, L.²⁸  Wyncoll, D.²⁹  Owall, A.³⁰ 

[1] Univ Hosp Graz, Dept Anaesthesiol & Intens Care Med, A-8036 Graz, Austria

[2] Med Univ Lubeck, Dept Anaesthesiol, D-23538 Lubeck, Germany

[3] Azienda Osped Univ Pisana, Dept Anaesthesia & Crit Care Med, Pisa, Italy

[4] Skanes Univ Hosp Lund, Dept Cardiothorac Surg, Lund, Sweden

[5] Univ Hosp Santiago de Compostela, Dept Anaesthesiol & Intens Care, Santiago De Compostela, Spain

[6] Aristotle Univ Thessaloniki, AHEPA Teaching Hosp, Dept Anaesthesiol, GR-54006 Thessaloniki, Greece

[7] Aristotle Univ Thessaloniki, AHEPA Teaching Hosp, Intens Care Unit, GR-54006 Thessaloniki, Greece

[8] Rabin Med Ctr, Heart Failure Unit, Petah Tiqwa, Israel

[9] Univ Hosp Hradec Kralove, Dept Anaesthesiol & Intens Care, Hradec Kralove, Czech Republic

[10] Hop Europeen Georges Pompidou, AP HP, Dept Anaesthesiol & Intens Care, Paris, France

[11] Univ Paris 05, Paris, France

[12] BV Petrovsky Russian Natl Ctr Surg, Moscow, Russia

[13] Univ Hosp Virgen de la Victoria Malaga, Dept Cardioanaesthesiol, Malaga, Spain

[14] Tampere Univ Hosp, Ctr Heart, Tampere, Finland

[15] Tampere Univ Hosp, Intens Care Unit, Tampere, Finland

[16] Univ Hosp Split, Dept Anaesthesiol & Intens Care, Split, Croatia

[17] Orion Phanna, Crit Care, Espoo, Finland

[18] Kuopio Univ Hosp, Dept Anaesthesiol & Intens Care, SF-70210 Kuopio, Finland

[19] EN Meshalkin State Novosibirsk Res Inst Circulat, Novosibirsk, Russia

[20] Duke Univ, Med Ctr, Dept Internal Med & Cardiol, Durham, NC USA

[21] Duke Clin Res Inst, Durham, NC USA

[22] Univ Clin Ctr Ljubljana, Dept Cardioanaesthesiol, Ljubljana, Slovenia

[23] UZ Leuven, Dept Anaesthesiol, Leuven, Belgium

[24] Inst Clin & Expt Med, Dept Anaesthesiol & Intens Care Med, Cardiothorac Anaesthesiol & Intens Care, Prague, Czech Republic

[25] Univ Zurich Hosp, Inst Anaesthesiol, CH-8091 Zurich, Switzerland

[26] Helsinki Univ Hosp, Dept Anaesthesiol Intens Care Emergency & Pain Me, Helsinki, Finland

[27] Gottsegen Gyorgy Natl Inst Cardiol, Dept Anaesthesiol & Intens Care, Budapest, Hungary

[28] Univ Roma La Sapienza, Policlin Umberto I, Dept Anaesthesiol & Intens Care, I-00185 Rome, Italy

[29] St Thomas Hosp, Dept Crit Care, London, England

[30] Karolinska Univ Hosp Solna, Dept Cardiothorac Surg, Stockholm, Sweden

关键词: Cardiac surgery;    CABG;    Valve surgery;    Low cardiac output syndrome;    Inodilator;    Cardioprotective;   

DOI  :  10.1016/j.ijcard.2015.02.022

来源: Elsevier

【 摘 要 】

In cardiac surgery, postoperative low cardiac output has been shown to correlate with increased rates of organ failure and mortality. Catecholamines have been the standard therapy for many years, although they carry substantial risk for adverse cardiac and systemic effects, and have been reported to be associated with increased mortality. On the other hand, the calcium sensitiser and potassium channel opener levosimendan has been shown to improve cardiac function with no imbalance in oxygen consumption, and to have protective effects in other organs. Numerous clinical trials have indicated favourable cardiac and non-cardiac effects of preoperative and perioperative administration of levosimendan. A panel of 27 experts from 18 countries has now reviewed the literature on the use of levosimendan in on-pump and off-pump coronary artery bypass grafting and in heart valve surgery. This panel discussed the published evidence in these various settings, and agreed to vote on a set of questions related to the cardioprotective effects of levosimendan when administered preoperatively, with the purpose of reaching a consensus on which patients could benefit from the preoperative use of levosimendan and in which kind of procedures, and at which doses and timing should levosimendan be administered. Here, we present a systematic review of the literature to report on the completed and ongoing studies on levosimendan, including the newly commenced LEVO-CTS phase III study (NCT02025621), and on the consensus reached on the recommendations proposed for the use of preoperative levosimendan. (C) 2015 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

【 授权许可】

Free