Anestéziológia a intenzívna medicína 2/2024

Effect of extracorporeal elimination therapy on the clinical efficacy of levosimendan in cardiac surgery patients with low left ventricular ejection fraction and acute postoperative renal failure

Objective: Monitoring of central hemodynamics in patients with acute renal insufficiency, with the need for continuous veno-venous hemodialysis after cardiac surgery. Effect of repeated dose of levosimendan was administered repeatedly optimization of the therapy with levosimendan. Material and methodology: 138 consecutive patients with ischemic heart disease (IHD) with severe systolic dysfunction (left ventricular ejection fraction ≤ 35%) who underwent coronary artery bypass grafting (CABG) using extracorporeal circulation and were initially under anesthesia were included in the study, levosimendan was administered after induction to general anaesthesia. Patients were divided into 3 groups. First group consists of a control group of patients. Two groups consists of patients, in whom early acute renal failure (1st postoperative day) occurred and extracorporeal elimination therapy (MEL) was necessary. Postoperatively the ejection fraction of the left ventricle was assessed using echocardiography on the 1st, 7th and 14th postoperative days and the values of cardiac output (CO), estimated by echocardiography and at the same time measured by non-invasive monitoring of central hemodynamics with compressive oscillometry (NIKO). Both non-invasive methods of measuring hemodynamics were done on the 1st, 7th and 14th postoperative days. Results: In each group of patients, there was an improvement in the measured parameters after the administration of levosimendan compared to the initial parameters. In both groups of patients with need of extracorporeal elimination therapy (MEL) in the form of CVVHD, all measured hemodynamic parameters worsened on the 7th postoperative day. In the control group of patients (without the need for extracorporeal elimination therapy), all measured parameters improved on the 7th postoperative day. We assume, that part of the drug was probably dialyzed. In the group of patients with the need for extracorporeal elimination therapy and repeated levosimendan administration, all measured parameters improved on the 14th postoperative day compared to the 7th and 1st postoperative day. However, in the group of patients with the need for extracorporeal elimination therapy, where due to the improved clinical condition of the patients on the 7th postoperative day, another dose of levosimendan was not administered, on the 14th postoperative day there was a decrease in all measured parameters compared to the 7th and compared to the 1st postoperative day. Conclusion: Repeated administration of levosimendan in patients with postoperative acute renal insufficiency and extracorporeal elimination in the form of continuous veno-venous hemodialysis was needed.We have found improved clinical condition and measured parameters − left ventricular ejection fraction and cardiac index.

Keywords: cardiac output, ejection fraction, cardiac surgery, levosimendan, acute renal failure, hemodialysis