Levosimendan Treatment in Patients with Primary Graft Dysfunction after Heart Transplantation

Abstract

Primary graft dysfunction or even failure (PGD/PGF) after heart transplantation (htx) remains a main problem causing poor outcome. Besides mechanical support Ca 2+-sensitizer such as levosimendan play an important role and are known to improve cardiac function. We aimed to analyse our patients particularly with regard to timing of levosimendan application. 139 patients underwent htx between 2010 and 2019 in our department, including 28 patients (22.4%) suffering from primary graft dysfunction or failure (PGD/PGF) and treated with levosimendan (group L). Patients who received the treatment within or after 48h after ECLS implantation form group Learly or Llate. Control group C consists of patients not treated with Ca 2+-sensitizer postoperatively. The groups were comparable regarding further preoperative status, including cardiac function and allograft ischemia time. 89.3% of group L were treated with extracorporeal life support (ECLS) compared to 13.4% of controls. In group Learly 100% of patients were successfully weaned from ECLS, in group Llate 60% and in group C 46.2% (p<0.05). However, thirty-day mortality was 17.9% in group L compared to 9.3% in controls (p>0.05). 1-year-survival was also comparable between the groups with 73.7% in group L and 77.6% in group C. Besides a more frequent use of postoperative ECLS, renal failure and need for resternotomy occurred significantly more often in group L compared to controls (p<0.05). Furthermore, stay on ICU and in hospital and duration of mechanical ventilation after htx were significantly prolonged (p<0.05). Patients receiving levosimendan early within the first 48 postoperative hours displayed lower thirty-day mortality and an improved 1-year-survival with 90% compared to 55.6% in group Llate (p>0.05). With our results, we could clearly show that levosimendan application in patients with PGD or even PGF after cardiac transplant represents a valuable treatment option to realize still acceptable results in these severely affected patients. Furthermore, it is obvious that the timely decision for early treatment with Ca 2+-sensitizer is an inevitable requirement to achieve those outcomes.