Effects of levosimendan on ventriculo-arterial coupling and cardiac efficiency in paediatric patients with single-ventricle physiology after surgical palliation: retrospective study

Medientyp: E-Artikel
Titel: Effects of levosimendan on ventriculo-arterial coupling and cardiac efficiency in paediatric patients with single-ventricle physiology after surgical palliation: retrospective study
Beteiligte: Iacobelli, Roberta; Ricci, Zaccaria; Marinari, Eleonora; Haiberger, Roberta; Di Molfetta, Arianna; Toscano, Alessandra; Di Chiara, Luca
Erschienen in: Interactive CardioVascular and Thoracic Surgery
Erschienen: Oxford University Press (OUP), 2020
Sprache: Englisch
DOI: 10.1093/icvts/ivz319
ISSN: 1569-9285
Schlagwörter: Cardiology and Cardiovascular Medicine ; Pulmonary and Respiratory Medicine ; Surgery
Zusammenfassung: <jats:title>Abstract</jats:title> <jats:sec> <jats:title /> <jats:p /> </jats:sec> <jats:sec> <jats:title>OBJECTIVES</jats:title> <jats:p>The use of levosimendan for paediatric patients with low cardiac output after congenital heart surgery has been recently described. We sought to evaluate ventriculo-arterial coupling (VAC) and other ventricular energetic parameters before and after 72 h from levosimendan start in infants with single-ventricle physiology and cardiac failure after palliation with Norwood or hybrid procedures.</jats:p> </jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>In this single-centre retrospective study, 9 consecutive patients affected by hypoplastic left heart syndrome-like anatomy were retrospectively analysed. Systolic elastance, diastolic elastance, arterial elastance, VAC and cardiac mechanical efficiency were calculated by measuring, through 2-dimensional echocardiography, end-systolic volume and end-diastolic volume and by recording mean arterial pressure and central venous pressure.</jats:p> </jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>The median (range) weight and age were 2.8 (2.3–6) kg and 16.5 (6–116) days, respectively. After 72 h from levosimendan start, end-systolic volume significantly decreased (−1 ml, −3.2 to −0.1, P = 0.007), whereas mean arterial pressure and end-diastolic volume remained stable. Heart rate showed a significant decrease (−28 beats/min, −41 to 22, P = 0.008). Systolic elastance (2.9 mmHg/ml, 0.4–5.4, P = 0.008), arterial elastance (−5.9, −24 to −0.5, P = 0.038), VAC (−0.86, −1.5 to −0.16, P = 0.009) and cardiac mechanical efficiency (0.18, 0.03–0.22, P = 0.008) differences also showed significant modifications.</jats:p> </jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>In a small case series of patients with single-ventricle physiology, levosimendan showed to improve contractility and optimize VAC, with a reduction of heart rate. Monitoring of VAC and ventricular energetics can be an interesting aspect to improve the management of heart failure in infants with univentricular anatomy.</jats:p> </jats:sec>
Beschreibung: <jats:title>Abstract</jats:title>
<jats:sec>
<jats:title />
<jats:p />
</jats:sec>
<jats:sec>
<jats:title>OBJECTIVES</jats:title>
<jats:p>The use of levosimendan for paediatric patients with low cardiac output after congenital heart surgery has been recently described. We sought to evaluate ventriculo-arterial coupling (VAC) and other ventricular energetic parameters before and after 72 h from levosimendan start in infants with single-ventricle physiology and cardiac failure after palliation with Norwood or hybrid procedures.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>METHODS</jats:title>
<jats:p>In this single-centre retrospective study, 9 consecutive patients affected by hypoplastic left heart syndrome-like anatomy were retrospectively analysed. Systolic elastance, diastolic elastance, arterial elastance, VAC and cardiac mechanical efficiency were calculated by measuring, through 2-dimensional echocardiography, end-systolic volume and end-diastolic volume and by recording mean arterial pressure and central venous pressure.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>RESULTS</jats:title>
<jats:p>The median (range) weight and age were 2.8 (2.3–6) kg and 16.5 (6–116) days, respectively. After 72 h from levosimendan start, end-systolic volume significantly decreased (−1 ml, −3.2 to −0.1, P = 0.007), whereas mean arterial pressure and end-diastolic volume remained stable. Heart rate showed a significant decrease (−28 beats/min, −41 to 22, P = 0.008). Systolic elastance (2.9 mmHg/ml, 0.4–5.4, P = 0.008), arterial elastance (−5.9, −24 to −0.5, P = 0.038), VAC (−0.86, −1.5 to −0.16, P = 0.009) and cardiac mechanical efficiency (0.18, 0.03–0.22, P = 0.008) differences also showed significant modifications.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>CONCLUSIONS</jats:title>
<jats:p>In a small case series of patients with single-ventricle physiology, levosimendan showed to improve contractility and optimize VAC, with a reduction of heart rate. Monitoring of VAC and ventricular energetics can be an interesting aspect to improve the management of heart failure in infants with univentricular anatomy.</jats:p>
</jats:sec>
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