[Hemodynamic effects of levosimendan compared with dobutamine in patients with low cardiac output after cardiac surgery]. / Comparación de los efectos hemodinámicos del levosimendán con la dobutamina en pacientes con bajo gasto después de cirugía cardiaca.

INTRODUCTION AND OBJECTIVES: Levosimendan is an inotropic agent that is effective in the treatment of heart failure. However, experience with levosimendan in patients with reduced cardiac output following cardiopulmonary bypass is limited. The objective of this study was to compare the short-term hemodynamic effects of levosimendan with those of dobutamine in managing low cardiac output after cardiac surgery. METHODS: Forty-one patients who had low cardiac output after cardiopulmonary bypass were randomly assigned to dobutamine (n=20), 24-hour infusion of 7.5 microg/kg per min, or levosimendan (n=21), at a loading dose of 12 microg/kg followed by 24-hour infusion of 0.2 microg/kg per min. The following parameters were determined during a 48-hour observation period: arterial, central venous, pulmonary arterial and pulmonary capillary wedge pressure, cardiac index, heart rate, stroke volume, and systemic and pulmonary vascular resistance. RESULTS: Although both dobutamine and levosimendan improved the cardiac index, the increase was significantly greater with levosimendan (2.4 [0.2] l/min per m2 vs 2.9 [0.3] l/min per m2, respectively, at 24 h; P<.05). Moreover, levosimendan significantly reduced systemic and pulmonary vascular resistance, and significantly decreased systemic arterial, pulmonary arterial, pulmonary capillary wedge, and central venous pressure. CONCLUSIONS: Both dobutamine and levosimendan are effective in managing postoperative low cardiac output. However, levosimendan induces non-specific systemic, venous and pulmonary vasodilation which can result in hypotension as a adverse event. In these patients, it is advisable to omit or reduce the loading dose.

Comparación de los efectos hemodinámicos del levosimendán con la dobutamina en pacientes con bajo gasto después de cirugía cardiaca / Hemodynamic effects of levosimendan compared with dobutamine in patients with low cardiac output after cardiac surgery

Introducción y objetivos. El levosimendán es un fármaco inotrópico positivo eficaz en la insuficiencia cardiaca. Sin embargo, la experiencia con levosimendán en pacientes con bajo gasto después de una cirugía cardiaca es reducida. El propósito de este estudio es comparar a corto plazo los efectos hemodinámicos del levosimendán frente a la dobutamina después de la cirugía cardiaca. Métodos. Se estudió a 41 pacientes con bajo gasto después de una cirugía cardiaca bajo circulación extracorpórea divididos en 2 grupos. Un grupo (n = 20) recibió una infusión continua de 7,5 μg/kg/min de dobutamina durante 24 h. Otro grupo (n = 21) recibió una dosis de carga de levosimendán de 12 μg/kg seguida de una infusión de 0,2 μg/kg/min durante 24 h. Se determinaron el gasto cardiaco, la frecuencia cardiaca, la presión arterial, la presión venosa central, la presión arterial pulmonar, la presión capilar, la resistencia vascular pulmonar y sistémica, y el volumen sistólico. Resultados. Ambos fármacos aumentaron significativamente el índice cardiaco aunque fue más marcado con el levosimendán (a las 24 h, 2,4 ± 0,2 frente a 2,9 ± 0,3 l/min/m²; p < 0,05). El levosimendán redujo significativamente la resistencia vascular sistémica y pulmonar y ocasionó un descenso significativo de la presión arterial sistémica, pulmonar, venosa central y capilar pulmonar. Conclusiones. El levosimendán y la dobutamina son eficaces en el tratamiento del bajo gasto después de la cirugía cardiaca. Sin embargo, el levosimendán ejerce un efecto vasodilatador inespecífico capaz de provocar hipotensión arterial. En estos pacientes es recomendable reducir o suprimir la dosis de carga

Introduction and objectives. Levosimendan is an inotropic agent that is effective in the treatment of heart failure. However, experience with levosimendan in patients with reduced cardiac output following cardiopulmonary bypass is limited. The objective of this study was to compare the short-term hemodynamic effects of levosimendan with those of dobutamine in managing low cardiac output after cardiac surgery. Methods. Forty-one patients who had low cardiac output after cardiopulmonary bypass were randomly assigned to dobutamine (n=20), 24-hour infusion of 7.5 μg/kg per min, or levosimendan (n=21), at a loading dose of 12 μg/kg followed by 24-hour infusion of 0.2 μg/kg per min. The following parameters were determined during a 48-hour observation period: arterial, central venous, pulmonary arterial and pulmonary capillary wedge pressure, cardiac index, heart rate, stroke volume, and systemic and pulmonary vascular resistance. Results. Although both dobutamine and levosimendan improved the cardiac index, the increase was significantly greater with levosimendan (2.4 [0.2] l/min per m² vs 2.9 [0.3] l/min per m2, respectively, at 24 h; P<.05). Moreover, levosimendan significantly reduced systemic and pulmonary vascular resistance, and significantly decreased systemic arterial, pulmonary arterial, pulmonary capillary wedge, and central venous pressure. Conclusions. Both dobutamine and levosimendan are effective in managing postoperative low cardiac output. However, levosimendan induces non-specific systemic, venous and pulmonary vasodilation which can result in hypotension as a adverse event. In these patients, it is advisable to omit or reduce the loading dose