Effect of Levosimendan and Milrinone Combination in Patients with Chronic Kidney Disease who Underwent Cardiac Surgery

Omer F. Dogan, Emjed Khalil, Davut Azboy, Erhan Hafız

The health sciences university, Adana Numune Research and Training Hospital, Adana, Turkey

Date, time and location: 2018.05.26 13:30, Press Hall, 2F

Abstract

• Objective:The effect of levosimendan combined with milrinone administration in patientswith chronic kidney disease (CKD) has not been invastigated in cardiac surgery patients. Our aim of this study was to investigate the hemodynamic effects of perioperativelevosimendan in combination with milrinone administration in CKD patients who underwentcardiac surgery.     Methods: 164 CKD patients (the mean age: 56 yrs) with poor left ventricle were included.Levosimendan andmilrinone were administered to 84 patients (study group; SG). The remaining 80 patientstreated with placebo (placebo group; PG). We compared cardiac output (CO), cardiac index(CI), systemic vascular resistance (SVRI), and pulmonary vascular resistance (PVR) immediately after surgeryand at 2 h, 6 h, 12 h, and 24 h after operation.   Results:The SG showed lower rates of postoperative low-cardiac output syndrome (29.3% vs.41.6%, P=0.001), and arrhytmia (26.8% vs. 44.6%) (P=0.01). CO and CI values wereincreased significantly in SG. PVR values were significantly low in SG(P=0.034).c-TnI and TNF-alpha levels were low in SG (P= 0.0001). Both groupshad higher mean LVEF in the postoperative compared with the preoperative period, but theaverage gain in LVEF in SG group was higher than in the PG (11.70±2.39 vs. 6.2±1.30)(P<0.001).  Conclusion:The use of levosimendan plus milrinone improved significantly hemodynamics in CKD patients with poor left ventricle.Duration of ICU and hospitalization were decreased significantly with inodilators treatment.