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Erschienen in: Wiener klinische Wochenschrift 15-16/2014

01.08.2014 | case report

Levosimendan reverses right-heart failure in a 51-year-old patient after heart transplantation

verfasst von: MD, PhD Stjepan Barisin, MD Viktor Djuzel, MD, PhD Ana Barisin, MD, PhD Igor Rudez

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 15-16/2014

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Summary

Primary graft failure in the early postoperative period after heart transplantation, remains a main cause of a poor outcome. Current treatment options include pharmacological (catecholamines and phosphodiesterase inhibitors) and mechanical assist device support. Pharmacological support with catecholamines is related to elevated myocardial oxygen consumption and regional hypoperfusion leading to organ damage. On the other hand, levosimendan, as a calcium-sensitizing agent increases cardiac contractility without altering intracellular Ca2+ levels and increase in oxygen demand.
We present a case of a 51-year-old man, who was suffering from acute right-heart failure in the early postoperative period after heart transplantation. As a rescue therapy at the late stage of a low cardiac output state, levosimendan was started as continuous infusion at 0.1 μg/kg/min for 12 h and thereafter, at 0.2 μg/kg/min for the following 36 h. Levosimendan demonstrated an advanced pharmacological option as was portrayed in this case, where the right ventricle was under a prolonged severe depression and acutely overloaded after heart transplantation.
Literatur
1.
Zurück zum Zitat Mitropoulos FA, Odim J, Marelli D, et al. Outcome of hearts with cold ischemic time greater than 300 min. A case-matched study. Eur J Cardiothorac Surg. 2005;28(1):143–8. PubMedCrossRef Mitropoulos FA, Odim J, Marelli D, et al. Outcome of hearts with cold ischemic time greater than 300 min. A case-matched study. Eur J Cardiothorac Surg. 2005;28(1):143–8. PubMedCrossRef
2.
Zurück zum Zitat Hauer D, Beiras-Fernandez A, Kur F, Weis M, Schmoeckel M, Weis FC. The management of severe primary graft failure after cardiac transplantation. J Cardiothorac Vasc Anesth. 2009;23(2):203–5. PubMedCrossRef Hauer D, Beiras-Fernandez A, Kur F, Weis M, Schmoeckel M, Weis FC. The management of severe primary graft failure after cardiac transplantation. J Cardiothorac Vasc Anesth. 2009;23(2):203–5. PubMedCrossRef
3.
Zurück zum Zitat Morais RJ. Levosimendan in severe right ventricular failure following mitral valve replacement. J Cardiothorac Vasc Anesth. 2006;20(1):82–4. PubMedCrossRef Morais RJ. Levosimendan in severe right ventricular failure following mitral valve replacement. J Cardiothorac Vasc Anesth. 2006;20(1):82–4. PubMedCrossRef
4.
Zurück zum Zitat Mebazaa A, Karpati P, Renaud E, Algotsson L. Acute right ventricular failure—from pathophysiology to new treatments. Intensive Care Med. 2004;30(2):185–96. PubMedCrossRef Mebazaa A, Karpati P, Renaud E, Algotsson L. Acute right ventricular failure—from pathophysiology to new treatments. Intensive Care Med. 2004;30(2):185–96. PubMedCrossRef
5.
Zurück zum Zitat Beiras-Fernandez A, Weis FC, Fuchs H, Meiser BM, Reichart B, Weis M. Levosimendan treatment after primary organ failure in heart transplantation: a direct way to recovery? Transplantation. 2006;82(8):1101–3. PubMedCrossRef Beiras-Fernandez A, Weis FC, Fuchs H, Meiser BM, Reichart B, Weis M. Levosimendan treatment after primary organ failure in heart transplantation: a direct way to recovery? Transplantation. 2006;82(8):1101–3. PubMedCrossRef
6.
Zurück zum Zitat Jahania MS, Mullett TW, Sanchez JA, Narayan P, Lasley RD, Mentzer RM Jr. Acute allograft failure in thoracic organ transplantation. J Card Surg. 2000;15(2):122–8. PubMed Jahania MS, Mullett TW, Sanchez JA, Narayan P, Lasley RD, Mentzer RM Jr. Acute allograft failure in thoracic organ transplantation. J Card Surg. 2000;15(2):122–8. PubMed
7.
Zurück zum Zitat Beiras-Fernandez A, Kur F, Kaczmarek I, et al. Levosimendan for primary graft failure after heart transplantation: a 3-year follow-up. Transplant Proc. 2011;43(6):2260–2. PubMedCrossRef Beiras-Fernandez A, Kur F, Kaczmarek I, et al. Levosimendan for primary graft failure after heart transplantation: a 3-year follow-up. Transplant Proc. 2011;43(6):2260–2. PubMedCrossRef
8.
Zurück zum Zitat Colucci WS, Wright RF, Jaski BE, Fifer MA, Braunwald E. Milrinone and dobutamine in severe heart failure: differing hemodynamic effects and individual patient responsiveness. Circulation. 1986;73(3):75–83. Colucci WS, Wright RF, Jaski BE, Fifer MA, Braunwald E. Milrinone and dobutamine in severe heart failure: differing hemodynamic effects and individual patient responsiveness. Circulation. 1986;73(3):75–83.
9.
Zurück zum Zitat Banfor PN, Preusser LC, Campbell TJ, et al. Comparative effects of levosimendan, OR-1896, OR-1855, dobutamine, and milrinone on vascular resistance, indexes of cardiac function, and O 2 consumption in dogs. Am J Physiol Heart Circ Physiol. 2008;294:238–48. CrossRef Banfor PN, Preusser LC, Campbell TJ, et al. Comparative effects of levosimendan, OR-1896, OR-1855, dobutamine, and milrinone on vascular resistance, indexes of cardiac function, and O 2 consumption in dogs. Am J Physiol Heart Circ Physiol. 2008;294:238–48. CrossRef
10.
Zurück zum Zitat Antila S, Kivikko M, Lehtonen L, et al. Pharmacokinetics of levosimendan and its circulating metabolites in patients with heart failure after an extended continuous infusion of levosimendan. Br J Clin Pharmacol. 2004;57(4):412–5. PubMedCentralPubMedCrossRef Antila S, Kivikko M, Lehtonen L, et al. Pharmacokinetics of levosimendan and its circulating metabolites in patients with heart failure after an extended continuous infusion of levosimendan. Br J Clin Pharmacol. 2004;57(4):412–5. PubMedCentralPubMedCrossRef
11.
Zurück zum Zitat Kivikko M, Antila S, Eha J, Lehtonen L, Pentikäinen PJ. Pharmacodynamics and safety of a new calcium sensitizer, levosimendan, and its metabolites during an extended infusion in patients with severe heart failure. J Clin Pharmacol. 2002;42(1):43–51. PubMedCrossRef Kivikko M, Antila S, Eha J, Lehtonen L, Pentikäinen PJ. Pharmacodynamics and safety of a new calcium sensitizer, levosimendan, and its metabolites during an extended infusion in patients with severe heart failure. J Clin Pharmacol. 2002;42(1):43–51. PubMedCrossRef
12.
Zurück zum Zitat Braun JP, Jasulaitis D, Moshirzadeh M, et al. Levosimendan may improve survival in patients requiring mechanical assist devices for post-cardiotomy heart failure. Crit Care. 2006;10:569–75. Braun JP, Jasulaitis D, Moshirzadeh M, et al. Levosimendan may improve survival in patients requiring mechanical assist devices for post-cardiotomy heart failure. Crit Care. 2006;10:569–75.
13.
Zurück zum Zitat Lilleberg J, Ylonene V, Lehtonen L, Toivonen L. The calcium sensitizer levosimendan and cardiac arrhythmias: an analysis of the safety database of heart failure treatment studies. Scand Cardiovasc J. 2004;38(2):80–4. PubMedCrossRef Lilleberg J, Ylonene V, Lehtonen L, Toivonen L. The calcium sensitizer levosimendan and cardiac arrhythmias: an analysis of the safety database of heart failure treatment studies. Scand Cardiovasc J. 2004;38(2):80–4. PubMedCrossRef
14.
Zurück zum Zitat Kivikko M, Antila S, Eha J, Lehtonen L, Pentikäinen PJ. Pharmacokinetics of levosimendan and its metabolites during and after a 24-hour continuous infusion in patients with severe heart failure. Int J Clin Pharmacol Ther. 2002;40(10):465–71. PubMedCrossRef Kivikko M, Antila S, Eha J, Lehtonen L, Pentikäinen PJ. Pharmacokinetics of levosimendan and its metabolites during and after a 24-hour continuous infusion in patients with severe heart failure. Int J Clin Pharmacol Ther. 2002;40(10):465–71. PubMedCrossRef
15.
Zurück zum Zitat Westphal M, Morelli A, Van Aken H. Dear levosimendan. the right ventricle will thank you! Crit Care Med. 2007;35(3):952–3. PubMedCrossRef Westphal M, Morelli A, Van Aken H. Dear levosimendan. the right ventricle will thank you! Crit Care Med. 2007;35(3):952–3. PubMedCrossRef
16.
Zurück zum Zitat Missant C, Rex S, Segers P, Wouters PF. Levosimendan improves right ventriculovascular coupling in a porcine model of right ventricular dysfunction. Crit Care Med. 2007;35(3):707–15. PubMedCrossRef Missant C, Rex S, Segers P, Wouters PF. Levosimendan improves right ventriculovascular coupling in a porcine model of right ventricular dysfunction. Crit Care Med. 2007;35(3):707–15. PubMedCrossRef
17.
Zurück zum Zitat Puttonen J, Kantele S, Kivikko M, et al. Effect of severe failure and haemodialysis on the pharmacokinetics of levosimendan and its metabolites. Clin Pharmacokinet. 2007;46(3):235–46. PubMedCrossRef Puttonen J, Kantele S, Kivikko M, et al. Effect of severe failure and haemodialysis on the pharmacokinetics of levosimendan and its metabolites. Clin Pharmacokinet. 2007;46(3):235–46. PubMedCrossRef
18.
Zurück zum Zitat Zemljic G, Bunc M, Yazdanbakhsh AP, Vrtovec B. Levosimendan improves renal function in patients with advanced chronic heart failure awaiting cardiac transplantation. J Cardiac Fail. 2007;13(6):417–21. CrossRef Zemljic G, Bunc M, Yazdanbakhsh AP, Vrtovec B. Levosimendan improves renal function in patients with advanced chronic heart failure awaiting cardiac transplantation. J Cardiac Fail. 2007;13(6):417–21. CrossRef
19.
Zurück zum Zitat Yilmaz MB, Yalta K, Yontar C, et al. Levosimendan improves renal function in patients with acute decompensated heart failure: comparison with dobutamine. Cardiovasc Drugs Ther. 2007;21(6):431–5. PubMedCrossRef Yilmaz MB, Yalta K, Yontar C, et al. Levosimendan improves renal function in patients with acute decompensated heart failure: comparison with dobutamine. Cardiovasc Drugs Ther. 2007;21(6):431–5. PubMedCrossRef
20.
Zurück zum Zitat Toller WG, Stranz C. Levosimendan, a new inotropic and vasodilator agent. Anesthesiology. 2006;104(3):556–69. PubMedCrossRef Toller WG, Stranz C. Levosimendan, a new inotropic and vasodilator agent. Anesthesiology. 2006;104(3):556–69. PubMedCrossRef
Metadaten
Titel
Levosimendan reverses right-heart failure in a 51-year-old patient after heart transplantation
verfasst von
MD, PhD Stjepan Barisin
MD Viktor Djuzel
MD, PhD Ana Barisin
MD, PhD Igor Rudez
Publikationsdatum
01.08.2014
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 15-16/2014
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-014-0528-2