Leivaditis Vasileios, Grapatsas Konstantinos, Papaporfyriou Anastasia, Galanis Michail, Koletsis Efstratios, Charokopos Nikolaos, Haussmann Erich, Kaplunov Vladislav, Papatriantafyllou Athanasios, Dahm Manfred
Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, 67655 Kaiserslautern, Germany.
Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, 45239 Essen, Germany.
J Cardiovasc Dev Dis. 2023 Aug 3;10(8):332. doi: 10.3390/jcdd10080332.
Postoperative myocardial dysfunction following cardiac surgery is a relatively common occurrence. Levosimendan, a calcium sensitizer and inotropic drug, has shown potential in improving outcomes for patients with low preoperative ejection fraction (EF) and myocardial dysfunction after cardiac surgery. This study aims to evaluate the efficacy of levosimendan in optimizing the surgical outcome for such patients.
A retrospective analysis was conducted on 314 patients with preoperative severe heart failure who underwent cardiac surgery. Among them, 184 patients received perioperative adjunctive therapy with levosimendan, while a comparable group of 130 patients received conventional treatment.
The use of levosimendan demonstrated several advantages in postoperative outcomes. It significantly improved short- and long-term survival rates after cardiac surgery, enhanced hemodynamic stability, reduced the requirement for inotropic support, and facilitated faster weaning from ventilator support. Patients who received levosimendan reported reduced angina and dyspnea symptoms, as well as fewer postoperative arrhythmias. Furthermore, levosimendan helped minimize myocardial injury inevitable after cardiac surgery. The levosimendan group also exhibited a notable reduction in hospital readmissions.
This study provides evidence of several benefits associated with the perioperative use of levosimendan. However, further prospective randomized studies are warranted to standardize and comprehensively document the other perioperative therapies, in order to validate these findings and establish stronger conclusions.
心脏手术后的心肌功能障碍较为常见。左西孟旦是一种钙增敏剂和正性肌力药物，已显示出在改善术前射血分数（EF）低且心脏手术后心肌功能障碍患者的预后方面具有潜力。本研究旨在评估左西孟旦对此类患者优化手术结局的疗效。
对314例接受心脏手术的术前严重心力衰竭患者进行回顾性分析。其中，184例患者在围手术期接受了左西孟旦辅助治疗，而130例可比患者接受了传统治疗。
使用左西孟旦在术后结局方面显示出若干优势。它显著提高了心脏手术后的短期和长期生存率，增强了血流动力学稳定性，减少了对正性肌力支持的需求，并促进了更快地脱离呼吸机支持。接受左西孟旦治疗的患者报告心绞痛和呼吸困难症状减轻，术后心律失常也较少。此外，左西孟旦有助于将心脏手术后不可避免的心肌损伤降至最低。左西孟旦组的再次住院率也显著降低。
本研究提供了围手术期使用左西孟旦相关的若干益处的证据。然而，有必要进行进一步的前瞻性随机研究，以规范并全面记录其他围手术期治疗方法，从而验证这些发现并得出更有力的结论。
