Effects of Preoperative Levosimendan on Perioperative Outcome after LVAD Implantation

 

 All articles of this category

Objectives: Perioperative mortality and complications still remain high after left ventricular assist device (LVAD) implantation, especially in highly compromised patient cohorts, hence further improvement of treatment strategies are strongly warranted. Here, we evaluate the effects of preoperative i.v. Levosimendan (SIMDAX)—an inodilator with sustained effects on cardioprotection, inotropy, and vasodilatation on 30-day mortality, as well as peri- and postoperative complications after LVAD implantation.

Methods: We retrospectively analyzed 200 patients (56.9 ± 11.8 years, 86.3% male, 59.0% with ischemic cardiomoypathy [ICM] and 39.0% with dilatative cardiomyopathy (DCM)) with LVAD implantation for end-stage heart failure between November 2010 and December 2018 in our center, out of which 99 (49.5%) received preoperative i.v. Levosimendan therapy within 7 days before LVAD-Implantation (Levo-group) following institutional standards. Student’s t-test, as well as Chi-Square test, was used for statistical comparisons.

Results: There were no significant differences regarding preoperative patient characteristics between the Levo-group and the non-Levosimendan group (control group). 30-day mortality was comparable in both groups, with 13.1% in the Levo-group vs. 11.3% in the control group (p = 0.69). No significant differences in peri- and postoperative complications between both groups could be observed with RV-failure in 25.5 versus 26.42% (p = 0.85), need for postoperative dialysis in 54.6 vs. 45.1% (p = 0.23), perioperative stroke in 10.1 versus 10.4% (p = 0.94) and sepsis in 18.2 vs. 11.3% (p = 0.32) of the patients in the Levo group vs. the control group, respectively. Further, the Levo group had significant more need for postoperative catecholamines with regards to the 24 hours vasoactive inotropic score (VIS), with 32.0 ± 20.2 VIS versus 20.3 ± 18.5 VIS (p = 0.01), respectively.

Conclusion: Preoperative use of Levosimendan therapy before LVAD implantation did not reduce 30-day mortality or incidence of peri- and postoperative complications in out cohort. Patients who received Levosimendan therapy before LVAD implantation did require significant higher doses of catecholamines perioperatively. Due to the limitations of this study inherent to its single-center and retrospective nature, more studies are warranted in order to evaluate the effects of preoperative Levosimendan therapy before LVAD implantation on clinical outcome.