Comparative Effect of Levosimendan and Milrinone in Cardiac Surgery Patients With Pulmonary Hypertension and Left Ventricular Dysfunction

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• 作者：Abhi Mishra ; MD ; DM^* ; Bhupesh Kumar ; MD ; DM^* ; ^{bhupeshkr@yahoo.com" class="auth_mail" title="E-mail the corresponding author} ; Vikas Dutta ; MD^* ; V.K. Arya ; MD^* ; Anand Kumar Mishra ; MCH^&dagger ;
• 关键词：pulmonary artery hypertension ; biventricular function ; milrinone ; levosimendan ; valvular heart surgery
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：30
• 期：3
• 页码：639-646
• 全文大小：1543 K

文摘

To compare the effects of levosimendan with milrinone in cardiac surgical patients with pulmonary hypertension and left ventricular dysfunction.

Design

A prospective, randomized study.

Setting

Tertiary care teaching hospital.

Participants

The study included patients with valvular heart disease and pulmonary artery hypertension undergoing valve surgery.

Interventions

Forty patients were allocated randomly to receive either milrinone, 50 µg/kg bolus followed by infusion at a rate of 0.5 µg/kg/min (group 1), or levosimendan, 10 µg/kg bolus followed by infusion at a rate of 0.1 µg/kg/min (group 2) for 24 hours after surgery.

Measurements and Main Results

Hemodynamic parameters were measured using a pulmonary artery catheter, and biventricular functions were assessed using echocardiography. Mean pulmonary artery pressures and the pulmonary vascular resistance index were comparable between the 2 groups at several time points in the intensive care unit. Biventricular function was comparable between both groups. Postcardiopulmonary bypass right ventricular systolic and diastolic functions decreased in both groups compared with baseline, whereas 6 hours postbypass left ventricular ejection fraction improved in patients with stenotic valvular lesions. Levosimendan use was associated with higher heart rate, increased cardiac index, decreased systemic vascular resistance index, and increased requirement of norepinephrine infusion compared with milrinone.

Conclusions

The results of this study demonstrated that levosimendan was not clinically better than milrinone. Levosimendan therapy resulted in a greater increase in heart rate, decrease in systemic vascular resistance, and a greater need for norepinephrine than in patients who received milrinone.