Şahin ŞENAY, Fevzi TORAMAN, Sinan DAĞDELEN, Hasan KARABULUT, Cem ALHAN

Ciddi Sol Ventrikül Disfonksiyonuna Bağlı Kalp Yetersizliği Olan Kalp Cerrahisi Hastalarında Preoperatif Levosimendan Kullanımı

Amaç: Bu çalışmada ileri derecede sol ventrikül fonksiyon bozukluğuna bağlı kalp yetersizliği olan kalp cerrahisi hastalarında preoperatif levosimendan kullanımının klinik ve hemodinamik etkilerini değerlendirmeyi amaçladık. Çalışma planı: Kardiyopulmoner bypass altında kalp cerrahisi planlanan sol ventrikül ejeksiyon fraksiyonu ≤ %30 olan 10 hasta prospektif olarak çalışmaya dahil edildi. Hastalara operasyondan 4 saat önce başlanıp toplam 24 saat devam edecek şekilde 0.1 mcg/kg/dk dozunda levosimendan uygulandı. Operasyon öncesinde, postoperatif 5. gün ve 1. ayda sol ventrikül ejeksiyon fraksiyonu ölçümleri yapıldı. Postoperatif dönemde 0,4,6,12 ve 24. saatlerde kardiyak indeks, pulmoner kapiller uç basıncı, sistemik vasküler rezistans indeksi, pulmoner vasküler rezistans indeksi, ortalama arteryel basınç, santral venöz basınç, ortalama pulmoner arter basıncı ölçülerek kaydedildi. Bulgular: Tüm hastalara koroner bypass operasyonu yapıldı, ek olarak bir hastada aort kapak replasmanı, bir hastada triküspit kapak tamiri, bir hastada mitral kapak tamiri, bir hastada da sol ventrikül anevrizmektomi işlemi yapıldı. Hastaların ortalama Euroscore puanları 6.5±2.7 idi. Postoperatif dönemde intaaortik balon pompası kullanımı gerekmedi. İnme, böbrek yetmezliği, major infeksiyon ve 1 aylık mortalite gözlenmedi. Pulmoner kapiller uç basıncı postoperatif dönemde istatiksel olarak anlamlı bir şekilde azaldı p =0.001 . Hastaların ortalama takip süresi 11.6± 5.7 ay range: 4–17 idi. Geç dönemde mortalite veya tekrar kardiyak girişim gereksinimi gözlenmedi. Sol ventrikül ejeksiyon fraksiyonu ölçümleri operasyon öncesinde; postoperatif 5. gün ve 1. ayda 27.5±3.1; 37.1±5.4 ve 40.3±10.7 % olarak gözlendi p=0.01 . Sonuç: İleri derecede sol ventrikül fonksiyon bozukluğuna bağlı kalp yetersizliği olan kalp cerrahisi hastalarında operasyon öncesi levosimendan kullanımı hemodinamik fonksiyon ve klinik sonuçları iyileştirebilir.

Preoperative Use of Levosimendan In Cardiac Surgery Patients With Heart Failure Due To Severe Left Ventricular Dysfunction

Objectives: We aimed to evaluate the clinical and hemodynamic eff ects of preoperative use of levosimendan in cardiac surgery patients with severe left ventricular dysfunction. Study design: Ten patients with poor ventricular function EF ≤30% undergoing cardiac surgery with cardiopulmonary bypass CPB were prospectively enrolled. Patients received levosimendan infusion of 0.1 mcg/kg/min, starting 4 hours before the surgical procedure to be continued for 24 hours. Measurements of ejection fraction were performed preoperatively and postoperatively on the 5th day and 1st month. Cardiac index, pulmonary capillary wedge pressure, systemic vascular resistance index, pulmonary vascular resistance index, mean arterial pressure, central venous pressure, mean pulmonary artery pressure was monitored at the postoperative 0th, 4th, 6th, 12th and 24th hours. Results: All the patients underwent coronary bypass surgery; one patient had aortic valve replacement, one had tricuspid valve repair, one had mitral valve repair and one had left ventricular aneurysmectomy additionally. Mean Euroscore of the group was 6.5±2.7. No postoperative IABP use, stroke, renal failure, major infection and 1 month mortality were observed. Pulmonary vascular resistance was signifi cantly reduced p =0.001 postoperatively. Mean follow up period was 11.6± 5.7 month range: 4–17 month . No late mortality or cardiac reintervention was observed. The ejection fraction at the preoperative, postoperative 1st day and postoperative 1st month were as 27.5±3.1; 37.1±5.4; 40.3±10.7 % respectively p=0.01 . Conclusion: Early use of levosimendan prior to the cardiac operation in patients with heart failure due to poor left ventricular function may improve hemodynamic function and clinical outcome.

Keywords:

ventricular dysfunction, cardiac surgery,

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