Preoperative Levosimendan therapy reduces postoperative right ventricular failure in patients undergoing left ventricular assist device implantation

Author:

Sugimura Yukiharu12ORCID,Kalampokas Nikolaos1,Arikan Metin1,Rellecke Phillip1,Dalyanoglu Hannan1,Tudorache Igor1ORCID,Westenfeld Ralf3ORCID,Boeken Udo1ORCID,Lichtenberg Artur1ORCID,Akhyari Payam12ORCID,Aubin Hug1ORCID

Affiliation:

1. Department of Cardiac Surgery, Medical Faculty and University Hospital, Heinrich-Heine-University Medical School , Duesseldorf, Germany

2. Department of Cardiac Surgery, Medical Faculty and RWTH University Hospital Aachen, RWTH Aachen University , Aachen, Germany

3. Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf , Duesseldorf, Germany

Abstract

AbstractOBJECTIVESPerioperative mortality and complications still remain high after left ventricular assist device (LVAD) implantation, especially in highly compromised patient cohorts. Here, we evaluate the effects of preoperative Levosimendan therapy on peri- and postoperative outcomes after LVAD implantation.METHODSWe retrospectively analysed 224 consecutive patients with LVAD implantation for end-stage heart failure between November 2010 and December 2019 in our centre with regard to short- and longer-term mortality as well as incidence of postoperative right ventricular failure (RV-F). Out of these, 117 (52.2%) received preoperative i.v. Levosimendan therapy within 7 days before LVAD implantation (Levo group).RESULTSIn-hospital, 30-day and 5-year mortality was comparable (in-hospital mortality: 18.8% vs 23.4%, P = 0.40; 30-day mortality: 12.0% vs 14.0%, P = 0.65; Levo vs control group). However, in the multivariate analysis, preoperative Levosimendan therapy significantly reduced postoperative RV-F but increased postoperative vasoactive inotropic score ([RV-F: odds ratio 2.153, confidence interval 1.146–4.047, P = 0.017; vasoactive inotropic score 24 h post-surgery: odds ratio 1.023, confidence interval 1.008–1.038, P = 0.002). These results were further confirmed by 1:1 propensity score matching of 74 patients in each group. Especially in the subgroup of patients with normal preoperative RV function, the prevalence of postoperative RV-F was significantly lower in the Levo- group as compared to the control group (17.6% vs 31.1%, P = 0.03; respectively).CONCLUSIONSPreoperative Levosimendan therapy reduces the risk of postoperative RV-F, especially in patients with normal preoperative RV function without effects on mortality up to 5 years after LVAD implantation.

Funder

Dept. of Cardiac Surgery, Medical Faculty

University Hospital, Heinrich Heine University Düsseldorf

Publisher

Oxford University Press (OUP)

Reference25 articles.

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4. Levosimendan in patients with left ventricular dysfunction undergoing cardiac surgery: an update meta-analysis and trial sequential analysis;Wang;Biomed Res Int,2018

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