Efficacy of levosimendan infusion in patients undergoing a left ventricular assist device implant in a propensity score matched analysis of the EUROMACS registry-the Euro LEVO-LVAD study.
LVAD
Right-sided heart failure
heart failure
levosimendan
mechanical circularity support
propensity score matching
Journal
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
ISSN: 1873-734X
Titre abrégé: Eur J Cardiothorac Surg
Pays: Germany
ID NLM: 8804069
Informations de publication
Date de publication:
02 05 2023
02 05 2023
Historique:
received:
21
10
2022
revised:
06
03
2023
accepted:
10
03
2023
medline:
10
5
2023
pubmed:
14
3
2023
entrez:
13
3
2023
Statut:
ppublish
Résumé
Early right-sided heart failure (RHF) was seen in 22% of recipients of a left ventricular assist device (LVAD) in the European Registry for Patients with Mechanical Circulatory Support (EUROMACS). However, the optimal treatment of post-LVAD RHF is not well known. Levosimendan has proven to be effective in patients with cardiogenic shock and in those with end-stage heart failure. We sought to evaluate the efficacy of levosimendan on post-LVAD RHF and 30-day and 1-year mortality. The EUROMACS Registry was used to identify adults with mainstream continuous-flow LVAD implants who were treated with preoperative levosimendan compared to a propensity matched control cohort. In total, 3661 patients received mainstream LVAD, of which 399 (11%) were treated with levosimendan pre-LVAD. Patients given levosimendan had a higher EUROMACS RHF score [4 (2- 5.5) vs 2 (2- 4); P < 0.001], received more right ventricular assist devices (RVAD) [32 (8%) vs 178 (5.5%); P = 0.038] and stayed longer in the intensive care unit post-LVAD implant [19 (8-35) vs 11(5-25); P < 0.001]. Yet, there was no significant difference in the rate of RHF, 30-day, or 1-year mortality. Also, in the matched cohort (357 patients taking levosimendan compared to an average of 622 controls across 20 imputations), we found no evidence for a difference in postoperative severe RHF, RVAD implant rate, length of stay in the intensive care unit or 30-day and 1-year mortality. In this analysis of the EUROMACS registry, we found no evidence for an association between levosimendan and early RHF or death, albeit patients taking levosimendan had much higher risk profiles. For a definitive conclusion, a multicentre, randomized study is warranted.
Identifiants
pubmed: 36912728
pii: 7076608
doi: 10.1093/ejcts/ezad095
pmc: PMC10693438
pii:
doi:
Substances chimiques
Simendan
349552KRHK
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : European Association for Cardio-Thoracic Surgery
Commentaires et corrections
Type : CommentIn
Informations de copyright
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
Références
JACC Heart Fail. 2015 Dec;3(12):956-64
pubmed: 26577618
Front Cardiovasc Med. 2022 Apr 28;9:888136
pubmed: 35571194
J Heart Lung Transplant. 2020 Aug;39(8):735-750
pubmed: 32386998
Thorac Cardiovasc Surg. 2020 Aug;68(5):401-409
pubmed: 31770777
Lancet. 2007 Oct 20;370(9596):1453-7
pubmed: 18064739
Eur J Cardiothorac Surg. 2015 May;47(5):770-6; discussion 776-7
pubmed: 25820161
J Thorac Cardiovasc Surg. 2009 Apr;137(4):971-7
pubmed: 19327526
BMJ. 2014 Mar 31;348:g2215
pubmed: 24687314
Eur J Cardiothorac Surg. 2020 Jan 1;57(1):176-182
pubmed: 31155645
ESC Heart Fail. 2019 Feb;6(1):174-181
pubmed: 30378288
Circ Cardiovasc Imaging. 2014 Mar;7(2):379-89
pubmed: 24642920
Eur J Cardiothorac Surg. 2022 Jun 15;62(1):
pubmed: 35150247
Artif Organs. 2020 May;44(5):533-534
pubmed: 31838742
J Heart Lung Transplant. 2015 Dec;34(12):1495-504
pubmed: 26520247
Circulation. 2018 Feb 27;137(9):891-906
pubmed: 28847897
ASAIO J. 2012 Jan-Feb;58(1):6-11
pubmed: 22157071
JAMA Oncol. 2018 Dec 1;4(12):1778-1779
pubmed: 30347042
Clin Pharmacokinet. 2007;46(7):535-52
pubmed: 17596101
N Engl J Med. 2009 Dec 03;361(23):2241-51
pubmed: 19920051
Int J Cardiol. 2015 Nov 1;198:241-50
pubmed: 26232775
N Engl J Med. 2007 Aug 30;357(9):885-96
pubmed: 17761592
Heart Fail Rev. 2022 Mar;27(2):493-505
pubmed: 33839989
J Am Coll Cardiol. 2008 Jun 3;51(22):2163-72
pubmed: 18510965
J Am Coll Cardiol. 2009 Jul 21;54(4):312-21
pubmed: 19608028
Br J Anaesth. 2015 Sep;115(3):337-9
pubmed: 26025239
J Cardiothorac Vasc Anesth. 2021 Aug;35(8):2483-2495
pubmed: 33583718