Abstract
BackgroundSeveral animal studies suggest beneficial effects on kidney function upon administration of levosimendan. As recent data from clinical studies are heterogeneous, we sought to investigate whether levosimendan is associated with improved postoperative kidney function in cardiac surgery patients with respect to timing of its administration.MethodsRetrospective, single centre, observational analysis at a university hospital in Berlin, Germany. All adult patients without preoperative renal dysfunction that underwent coronary artery bypass grafting and/or valve reconstruction/replacement between 01/01/2007 and 31/12/2011 were considered for analyses.ResultsOut of 1.095 included patients, 46 patients were treated with levosimendan due to a severely reduced left ventricular systolic function preoperatively (LVEF < 35%) and/or clinical signs of a low cardiac output syndrome. Sixty-one percent received the drug whilst in the OR, 39% after postoperative intensive care unit admission. When levosimendan was given immediately after anaesthesia induction, creatinine plasma levels (p = 0.009 for nonparametric analysis of longitudinal data in a two-factorial design) and incidence of postoperative renal dysfunction (67.9% vs. 94.4%; p = 0.033) were significantly reduced in contrast to a later start of treatment. In addition, duration of renal replacement therapy was significantly shorter (79 [35;332] vs. 272 [132;703] minutes; p = 0.046) in that group.ConclusionsPostoperative kidney dysfunction is a common condition in patients under going cardiac surgery. Patients with severely reduced left ventricular function and/or clinical signs of a low cardiac output syndrome who preoperatively presented with a normal kidney function may benefit from an early start of levosimendan administration, i.e. immediately after anaesthesia.Trial registrationClinicaltrials.gov-ID: NCT01918618.Electronic supplementary materialThe online version of this article (doi:10.1186/s13019-014-0167-8) contains supplementary material, which is available to authorized users.
Highlights
Several animal studies suggest beneficial effects on kidney function upon administration of levosimendan
Study ID number: EA1-044-13; ClinGov. registration number: NCT01918618), we reviewed the charts and data derived from two electronic patient data management systems (COPRA System, Sasbachwalden, Germany and SAP, Walldorf, Germany) of all patients (≥18 years) admitted to our 28-beds intensive care unit (ICU) of the department of anaesthesiology and intensive care medicine at the Campus Charité Mitte, Berlin, between 01/01/2007 and 31/12/2011
In total, 9.634 patients were admitted to our ICU during the specified study period
Summary
Several animal studies suggest beneficial effects on kidney function upon administration of levosimendan. As recent data from clinical studies are heterogeneous, we sought to investigate whether levosimendan is associated with improved postoperative kidney function in cardiac surgery patients with respect to timing of its administration. In consequence, protecting organ function in the operative setting plays an important role for improving patient outcome. Levosimendan is a long acting calcium sensitizer derived from pyridazinone-dinitrile [3]. It enhances contractility without increasing oxygen consumption by calcium concentration-dependent conformational changes in troponine C. Anti-apoptotic properties in combination with a protective effect against ischemic injury in the heart mediated by activation of mitochondrial K(ATP) channels have been described [6,7]. Levosimendan has only recently been approved for perioperative usage in Germany and in consequence, its usage varies among cardiac anaesthesiologist and intensive care practitioners
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