Case ReportPre-operative Use of Levosimendan in Two Patients with Severe Aortic Stenosis and Left Ventricular Dysfunction
Section snippets
Case 1
A 63-year-old male was transferred to our hospital with refractory heart failure. Echocardiography performed 3 years earlier, whilst asymptomatic, showed severe AS, but normal LV systolic function and the patient declined valve surgery at that time. He recently developed worsening dyspnoea and in the last 3 months was admitted to a local hospital on three occasions with heart failure. On examination, heart rate was 86 and blood pressure 110/90 mmHg. Jugular venous pressure (JVP) was markedly
Discussion
This is the first report we are aware of in which levosimendan has been used in the setting of severe AS. Although the use of levosimendan has been shown to be beneficial for decompensated chronic heart failure,7 patients with significant AS have been specifically excluded from studies. Despite being shown to be beneficial in the treatment of heart failure due to LV systolic dysfunction, it has been conventionally accepted that drugs with vasodilator activity are contra-indicated in the
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Cited by (10)
Levosimendan in patients with left ventricular systolic dysfunction undergoing cardiac surgery on cardiopulmonary bypass: Rationale and study design of the Levosimendan in Patients with Left Ventricular Systolic Dysfunction Undergoing Cardiac Surgery Requiring Cardiopulmonary Bypass (LEVO-CTS) trial
2016, American Heart JournalCitation Excerpt :These results suggest that levosimendan is associated with better weaning from CPB, lower inotropic use, lower incidence of periprocedural MI, and lower lactate levels resulting from better tissue perfusion.18 Smaller randomized trials have further supported the efficacy of levosimendan in the treatment and prevention of LCOS in high-risk patients undergoing cardiac surgery.5,6,8,18-23 No increase in myocardial oxygen consumption or impairment of diastolic function was observed.17
Severe aortic stenosis and cardiogenic shock: A therapeutic challenge
2013, Revista Portuguesa de CardiologiaLevosimendan: Molecular mechanisms and clinical implications: Consensus of experts on the mechanisms of action of levosimendan
2012, International Journal of CardiologyCitation Excerpt :The latter mechanism is particularly interesting because agonists of mitochondrial ATP-sensitive K+ channels appear to confer protection against a variety of potentially lethal stressful conditions [66]. Short-term cardioprotection by levosimendan have been verified by a large number of clinical investigations [67–74], where the effects resembled those observed in experiments mimicking myocardial pre- or postconditioning [75–78] and/or myocardial stunning [79–81]. Longer-term cardioprotection has been also intimated by preclinical studies where levosimendan and/or OR-1896 mitigated cardiomyocyte apoptosis, cardiac remodeling and myocardial inflammation [82–86].
Levosimendan in patients with left ventricular dysfunction undergoing cardiac surgery
2017, New England Journal of MedicineUse of levosimendan in critically ill patients with severe aortic stenosis and left ventricular dysfunction
2012, European Heart Journal: Acute Cardiovascular Care