.: ORİJİNAL ARAŞTIRMA
Prophylactic Use of Levosimendan in High-Risk Coronary Artery Disease: Retrospective Clinical Research
Yüksek Riskli Koroner Arter Hastalarında Profilaktik Levosimendan Kullanımı: Retrospektif Klinik Araştırma
Turkiye Klinikleri J Cardiovasc Sci. 2022;34(1):1-6
doi: 10.5336/cardiosci.2021-83584
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: To investigate the perioperative and postoperative effects of preoperative levosimendan use in coronary artery patients with low ejection fraction (EF) (<40%). Material and Methods: A total of 6,571 coronary bypass patients who were treated at Kartal Koşuyolu High Specialization Training and Research Hospital between 2016 and 2019 were scanned, and 132 patients with preoperative EF below 40% were retrospectively analyzed. The patients were divided into 2 groups as those who received preoperative levosimendan (Group 1: 90 patients) and the control group, who did not receive it at all (Group 2: 42 patients). All of the patients included in the study were onpump coronary bypass patients and excluded off-pump bypass, emergency bypass, and other concomitant procedures. Results: In terms of EF values, improvements over time were significantly different in favor of Group 1 (p<0.043). The duration of the intensive care unit stay in Group 1 was longer (p<0.047). The changes in patients in terms of postoperative venous oxygen saturation over time were found to be statistically positive in favor of Group 1 (p<0.042). Mortality was observed in 5 patients in the postoperative early period (first 30 days), all of whom were from Group 1. However, no statistical difference was observed. Conclusion: Preoperative use of levosimendan in coronary artery patients with low EF improved some hemodynamic parameters; however, it did not make a significant hemodynamic and clinical contribution to surgery success in high-risk patients.
Keywords: Levosimendan; coronary bypass; ejection fraction
Objective: To investigate the perioperative and postoperative effects of preoperative levosimendan use in coronary artery patients with low ejection fraction (EF) (<40%). Material and Methods: A total of 6,571 coronary bypass patients who were treated at Kartal Koşuyolu High Specialization Training and Research Hospital between 2016 and 2019 were scanned, and 132 patients with preoperative EF below 40% were retrospectively analyzed. The patients were divided into 2 groups as those who received preoperative levosimendan (Group 1: 90 patients) and the control group, who did not receive it at all (Group 2: 42 patients). All of the patients included in the study were onpump coronary bypass patients and excluded off-pump bypass, emergency bypass, and other concomitant procedures. Results: In terms of EF values, improvements over time were significantly different in favor of Group 1 (p<0.043). The duration of the intensive care unit stay in Group 1 was longer (p<0.047). The changes in patients in terms of postoperative venous oxygen saturation over time were found to be statistically positive in favor of Group 1 (p<0.042). Mortality was observed in 5 patients in the postoperative early period (first 30 days), all of whom were from Group 1. However, no statistical difference was observed. Conclusion: Preoperative use of levosimendan in coronary artery patients with low EF improved some hemodynamic parameters; however, it did not make a significant hemodynamic and clinical contribution to surgery success in high-risk patients.
Keywords: Levosimendan; coronary bypass; ejection fraction
ÖZET
Amaç: Ejeksiyon fraksiyonu (EF) düşük (<%40) olan koroner arter hastalarında preoperatif levosimendan kullanımının perioperatif ve postoperatif etkilerinin incelenmesi. Gereç ve Yöntemler: Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesinde 2016 ile 2019 arasında koroner baypas yapılmış olan toplam 6.571 hasta tarandı ve preoperatif EF'si %40'ın altında olan 132 hasta geriye dönük olarak incelendi. Hastalar preoperatif levosimendan alanlar (Grup 1:90 hasta) ve hiç almayan kontroller (Grup 2: 42 hasta) olmak üzere 2 gruba ayrıldı. Çalışmaya On-pump bypass hastaları dahil edildi ve Off-pump baypas, acil baypas ve diğer eşzamanlı işlemler yapılan hastalar alınmadı. Bulgular: EF değerleri açısından, zaman içindeki düzelmeler Grup 1 lehine anlamlı olarak farklıydı (p<0,043). Grup 1'de yoğun bakımda kalış süresi daha uzundu (p<0,047). Hastalarda zaman içinde postoperatif venöz oksijen saturasyonundaki değişmeler Grup 1 lehine istatistiksel olarak pozitifti (p<0,042). Postoperatif erken dönemde (ilk 30 gün) tamamı Grup 1'de olan 5 hastada mortalite gerçekleşti. Fakat istatistiksel anlam bulunmadı. Sonuç: Ejeksiyon fraksiyonu düşük koroner arter hastalarında preoperatif levosimendan kullanımı bazı hemodinamik parametreleri düzeltti fakat yüksek riskli hastalarda cerrahi başarısına anlamlı hemodinamik ve klinik katkısı olmadı.
Anahtar Kelimeler: Levosimendan; koroner baypas; ejeksiyon fraksiyonu
Amaç: Ejeksiyon fraksiyonu (EF) düşük (<%40) olan koroner arter hastalarında preoperatif levosimendan kullanımının perioperatif ve postoperatif etkilerinin incelenmesi. Gereç ve Yöntemler: Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesinde 2016 ile 2019 arasında koroner baypas yapılmış olan toplam 6.571 hasta tarandı ve preoperatif EF'si %40'ın altında olan 132 hasta geriye dönük olarak incelendi. Hastalar preoperatif levosimendan alanlar (Grup 1:90 hasta) ve hiç almayan kontroller (Grup 2: 42 hasta) olmak üzere 2 gruba ayrıldı. Çalışmaya On-pump bypass hastaları dahil edildi ve Off-pump baypas, acil baypas ve diğer eşzamanlı işlemler yapılan hastalar alınmadı. Bulgular: EF değerleri açısından, zaman içindeki düzelmeler Grup 1 lehine anlamlı olarak farklıydı (p<0,043). Grup 1'de yoğun bakımda kalış süresi daha uzundu (p<0,047). Hastalarda zaman içinde postoperatif venöz oksijen saturasyonundaki değişmeler Grup 1 lehine istatistiksel olarak pozitifti (p<0,042). Postoperatif erken dönemde (ilk 30 gün) tamamı Grup 1'de olan 5 hastada mortalite gerçekleşti. Fakat istatistiksel anlam bulunmadı. Sonuç: Ejeksiyon fraksiyonu düşük koroner arter hastalarında preoperatif levosimendan kullanımı bazı hemodinamik parametreleri düzeltti fakat yüksek riskli hastalarda cerrahi başarısına anlamlı hemodinamik ve klinik katkısı olmadı.
Anahtar Kelimeler: Levosimendan; koroner baypas; ejeksiyon fraksiyonu
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