Safety and efficacy of levosimendan in a cardiothoracic ICU – 5 year data

Abstract

Introduction Levosimedan is an intravenous inodilator drug for the treatment of acute heart failure. There is a paucity of real-life physiological data with respect to the efficacy and safety of Levosimendan. We report the 5-year experience of a Tertiary UK Cardio-thoracic Intensive Care Unit (CT ICU). Methods Data was retrospectively analysed from a single centre CT ICU patient information system (Philips ICCA). Data from all patients receiving Levosimendan who survived > 48 hours after Levosimendan infusion were analysed. Results 165 consecutive patients treated with Levosimendan were analysed between Jan 2013 and Jan 2018. Mean age 59.8±16 years, 69.7% male. Indications and associated percentages are as follows: pre cardiac surgery optimisation for patients with left ventricular dysfunction 17.6%, failure to wean off inotropic support post-cardiac surgery 23%, VA-ECMO weaning 19.4%, right ventricular (RV) support post LVAD implantation 2.4%, RV support post cardiac transplant 6% and for acutely decompensated severe chronic heart failure 31.5%. Pre and post inotropic changes with Levosimendan findings are reported in table 1. At 72 hours (a priori specified time point), Levosimendan was associated with a significant reduction in pre- and post-dosage VIS (vasopressor inotropic score) [7(0-571) vs 2(0-428), p Discussion To our knowledge this is the first report and largest review of Levosimendan experience at a tertiary UK CT ICU over a 5-year period. Levosimendan was associated with a significant reduction in Vasopressor/inotropic score at 72 hours and a relative modest increase in inotropy as measured by LVEF and CI. These data suggest measurements specific to the ventriculoarterial coupling response should help phenotype which patients could benefit from this drug.