Zheng Qiang, Lan Hongwen, Guo Qiannan, Li Chenghao, Xiong Tixiusi, Zhang Jing, Wang Guohua, Dong Nianguo, Shi Jiawei
Department of Cardiovascular Surgery, Union Hospital Tongji Medical College, Huazhong University of Science and Technology, 430022 Wuhan, Hubei, China.
Heart Surg Forum. 2023 Aug 14;26(4):E346-E357. doi: 10.59958/hsf.5433.
The cardio-renal syndrome and hepatic impairment play a critical role in end-stage heart failure (HF). Levosimendan is an effective inotropic agent used to maintain cardiac output similar to classic cardiotonic like dobutamine/dopamine. This current research aims to investigate the clinical outcomes of levosimendan and dobutamine/dopamine in Chinese heart transplant awaiting patients with severe hepatic or renal impairment.
We performed a retrospective analysis of 568 heart transplant awaiting individuals with severe hepatic or renal impairment who treated with levosimendan or dobutamine/dopamine in our institution between January 2015 and December 2020. Univariate Cox proportional hazard models and Kaplan-Meier survival curves were applied. The primary endpoint was defined as death included inhospital mortality and the mortality at 30 days, 90 days, 180 days and 1 year after heart transplantation.
There were no significant differences in mortality rate at 30, 90, 180 days and 1 years after heart transplantation between the levosimendan and non-levosimendan groups, or between subgroups of patients with severe hepatic impairment or renal impairment. The results were consistent before and after propensity score matching.
In the population with advanced heart failure awaiting heart transplantation, levosimendan did not increase short- or long-term mortality rates after surgery compared to dobutamine/dopamine, regardless of their hepatic or renal function. Severe hepatic or renal impairment were not necessarily considered a contraindication for levosimendan in these patients.
心肾综合征和肝损伤在终末期心力衰竭（HF）中起关键作用。左西孟旦是一种有效的正性肌力药物，用于维持心输出量，类似于多巴酚丁胺/多巴胺等经典强心剂。本研究旨在调查左西孟旦与多巴酚丁胺/多巴胺在中国等待心脏移植且伴有严重肝或肾功能损害患者中的临床结局。
我们对2015年1月至2020年12月期间在本机构接受左西孟旦或多巴酚丁胺/多巴胺治疗的568例等待心脏移植且伴有严重肝或肾功能损害的个体进行了回顾性分析。应用单因素Cox比例风险模型和Kaplan-Meier生存曲线。主要终点定义为死亡，包括住院死亡率以及心脏移植后30天、90天、180天和1年的死亡率。
左西孟旦组与非左西孟旦组之间，以及严重肝损害或肾损害患者亚组之间，心脏移植后30天、90天、180天和1年的死亡率无显著差异。倾向评分匹配前后结果一致。
在等待心脏移植的晚期心力衰竭患者中，与多巴酚丁胺/多巴胺相比，无论其肝或肾功能如何，左西孟旦术后短期或长期死亡率均未增加。严重肝或肾功能损害不一定被视为这些患者使用左西孟旦的禁忌证。
