Levosimendan Versus Milrinone for Inotropic Support in Pediatric Cardiac Surgery: Results From a Randomized Trial

Elin M Thorlacius; Håkan Wåhlander; Tiina Ojala; Kaisa Ylänen; Juho Keski-Nisula; Mats Synnergren; Birgitta S Romlin; Sven-Erik Ricksten; Albert Castellheim

doi:10.1053/j.jvca.2020.02.027

Levosimendan Versus Milrinone for Inotropic Support in Pediatric Cardiac Surgery: Results From a Randomized Trial

Elin M Thorlacius, Håkan Wåhlander, Tiina Ojala, Kaisa Ylänen, Juho Keski-Nisula, Mats Synnergren, Birgitta S Romlin, Sven-Erik Ricksten, Albert Castellheim

Tutkimustuotos: Artikkeli › Tieteellinen › vertaisarvioitu

13 Sitaatiot (Scopus)

Abstrakti

OBJECTIVE: The present study aimed to determine the differential effects of intraoperative administration of milrinone versus levosimendan on myocardial function after pediatric cardiac surgery. Transthoracic echocardiography was used for myocardial function evaluation using biventricular longitudinal strain with 2-dimensional speckle tracking echocardiography in addition to conventional echocardiographic variables.

DESIGN: A secondary analysis of a randomized, prospective, double-blinded clinical drug trial.

SETTING: Two pediatric tertiary university hospitals.

PARTICIPANTS: Infants between 1 and 12 months old diagnosed with ventricular septal defect, complete atrioventricular septal defect, or tetralogy of Fallot who were scheduled for corrective surgery with cardiopulmonary bypass.

INTERVENTIONS: The patients were randomly assigned to receive an infusion of milrinone or levosimendan at the start of cardiopulmonary bypass and for 26 consecutive hours.

MEASUREMENTS AND MAIN RESULTS: Biventricular longitudinal strain and conventional echocardiographic variables were measured preoperatively, on the first postoperative morning, and before hospital discharge. The association between perioperative parameters and postoperative myocardial function also was investigated. Images were analyzed for left ventricular (n = 67) and right ventricular (n = 44) function. The day after surgery, left ventricular longitudinal strain deteriorated in both the milrinone and levosimendan groups (33% and 39%, respectively). The difference was not significant. The corresponding deterioration in right ventricular longitudinal strain was 42% and 50% (nonsignificant difference). For both groups, biventricular longitudinal strain approached preoperative values at hospital discharge. Preoperative N-terminal pro-brain natriuretic peptide could predict the left ventricular strain on postoperative day 1 (p = 0.014).

CONCLUSIONS: Levosimendan was comparable with milrinone for left and right ventricular inotropic support in pediatric cardiac surgery.

Alkuperäiskieli	Englanti
Sivut	2072-2080
Sivumäärä	9
Julkaisu	J Cardiothorac Vasc Anesth
Vuosikerta	34
Numero	8
DOI - pysyväislinkit	https://doi.org/10.1053/j.jvca.2020.02.027
Tila	Julkaistu - elok. 2020
Julkaistu ulkoisesti	Kyllä
OKM-julkaisutyyppi	A1 Alkuperäisartikkeli tieteellisessä aikakauslehdessä

Pääsy asiakirjaan

10.1053/j.jvca.2020.02.027

Siteeraa tätä

@article{fe3b5e6dfab546f7ae6b8bee4341e599,

title = "Levosimendan Versus Milrinone for Inotropic Support in Pediatric Cardiac Surgery: Results From a Randomized Trial",

abstract = "OBJECTIVE: The present study aimed to determine the differential effects of intraoperative administration of milrinone versus levosimendan on myocardial function after pediatric cardiac surgery. Transthoracic echocardiography was used for myocardial function evaluation using biventricular longitudinal strain with 2-dimensional speckle tracking echocardiography in addition to conventional echocardiographic variables.DESIGN: A secondary analysis of a randomized, prospective, double-blinded clinical drug trial.SETTING: Two pediatric tertiary university hospitals.PARTICIPANTS: Infants between 1 and 12 months old diagnosed with ventricular septal defect, complete atrioventricular septal defect, or tetralogy of Fallot who were scheduled for corrective surgery with cardiopulmonary bypass.INTERVENTIONS: The patients were randomly assigned to receive an infusion of milrinone or levosimendan at the start of cardiopulmonary bypass and for 26 consecutive hours.MEASUREMENTS AND MAIN RESULTS: Biventricular longitudinal strain and conventional echocardiographic variables were measured preoperatively, on the first postoperative morning, and before hospital discharge. The association between perioperative parameters and postoperative myocardial function also was investigated. Images were analyzed for left ventricular (n = 67) and right ventricular (n = 44) function. The day after surgery, left ventricular longitudinal strain deteriorated in both the milrinone and levosimendan groups (33% and 39%, respectively). The difference was not significant. The corresponding deterioration in right ventricular longitudinal strain was 42% and 50% (nonsignificant difference). For both groups, biventricular longitudinal strain approached preoperative values at hospital discharge. Preoperative N-terminal pro-brain natriuretic peptide could predict the left ventricular strain on postoperative day 1 (p = 0.014).CONCLUSIONS: Levosimendan was comparable with milrinone for left and right ventricular inotropic support in pediatric cardiac surgery.",

keywords = "Cardiac Surgical Procedures, Cardiotonic Agents/therapeutic use, Child, Humans, Hydrazones, Infant, Milrinone, Prospective Studies, Pyridazines, Simendan",

author = "Thorlacius, {Elin M} and H{\aa}kan W{\aa}hlander and Tiina Ojala and Kaisa Yl{\"a}nen and Juho Keski-Nisula and Mats Synnergren and Romlin, {Birgitta S} and Sven-Erik Ricksten and Albert Castellheim",

year = "2020",

month = aug,

doi = "10.1053/j.jvca.2020.02.027",

language = "English",

volume = "34",

pages = "2072--2080",

number = "8",

}

TY - JOUR

T1 - Levosimendan Versus Milrinone for Inotropic Support in Pediatric Cardiac Surgery

T2 - Results From a Randomized Trial

AU - Thorlacius, Elin M

AU - Wåhlander, Håkan

AU - Ojala, Tiina

AU - Ylänen, Kaisa

AU - Keski-Nisula, Juho

AU - Synnergren, Mats

AU - Romlin, Birgitta S

AU - Ricksten, Sven-Erik

AU - Castellheim, Albert

PY - 2020/8

Y1 - 2020/8

N2 - OBJECTIVE: The present study aimed to determine the differential effects of intraoperative administration of milrinone versus levosimendan on myocardial function after pediatric cardiac surgery. Transthoracic echocardiography was used for myocardial function evaluation using biventricular longitudinal strain with 2-dimensional speckle tracking echocardiography in addition to conventional echocardiographic variables.DESIGN: A secondary analysis of a randomized, prospective, double-blinded clinical drug trial.SETTING: Two pediatric tertiary university hospitals.PARTICIPANTS: Infants between 1 and 12 months old diagnosed with ventricular septal defect, complete atrioventricular septal defect, or tetralogy of Fallot who were scheduled for corrective surgery with cardiopulmonary bypass.INTERVENTIONS: The patients were randomly assigned to receive an infusion of milrinone or levosimendan at the start of cardiopulmonary bypass and for 26 consecutive hours.MEASUREMENTS AND MAIN RESULTS: Biventricular longitudinal strain and conventional echocardiographic variables were measured preoperatively, on the first postoperative morning, and before hospital discharge. The association between perioperative parameters and postoperative myocardial function also was investigated. Images were analyzed for left ventricular (n = 67) and right ventricular (n = 44) function. The day after surgery, left ventricular longitudinal strain deteriorated in both the milrinone and levosimendan groups (33% and 39%, respectively). The difference was not significant. The corresponding deterioration in right ventricular longitudinal strain was 42% and 50% (nonsignificant difference). For both groups, biventricular longitudinal strain approached preoperative values at hospital discharge. Preoperative N-terminal pro-brain natriuretic peptide could predict the left ventricular strain on postoperative day 1 (p = 0.014).CONCLUSIONS: Levosimendan was comparable with milrinone for left and right ventricular inotropic support in pediatric cardiac surgery.

AB - OBJECTIVE: The present study aimed to determine the differential effects of intraoperative administration of milrinone versus levosimendan on myocardial function after pediatric cardiac surgery. Transthoracic echocardiography was used for myocardial function evaluation using biventricular longitudinal strain with 2-dimensional speckle tracking echocardiography in addition to conventional echocardiographic variables.DESIGN: A secondary analysis of a randomized, prospective, double-blinded clinical drug trial.SETTING: Two pediatric tertiary university hospitals.PARTICIPANTS: Infants between 1 and 12 months old diagnosed with ventricular septal defect, complete atrioventricular septal defect, or tetralogy of Fallot who were scheduled for corrective surgery with cardiopulmonary bypass.INTERVENTIONS: The patients were randomly assigned to receive an infusion of milrinone or levosimendan at the start of cardiopulmonary bypass and for 26 consecutive hours.MEASUREMENTS AND MAIN RESULTS: Biventricular longitudinal strain and conventional echocardiographic variables were measured preoperatively, on the first postoperative morning, and before hospital discharge. The association between perioperative parameters and postoperative myocardial function also was investigated. Images were analyzed for left ventricular (n = 67) and right ventricular (n = 44) function. The day after surgery, left ventricular longitudinal strain deteriorated in both the milrinone and levosimendan groups (33% and 39%, respectively). The difference was not significant. The corresponding deterioration in right ventricular longitudinal strain was 42% and 50% (nonsignificant difference). For both groups, biventricular longitudinal strain approached preoperative values at hospital discharge. Preoperative N-terminal pro-brain natriuretic peptide could predict the left ventricular strain on postoperative day 1 (p = 0.014).CONCLUSIONS: Levosimendan was comparable with milrinone for left and right ventricular inotropic support in pediatric cardiac surgery.

KW - Cardiac Surgical Procedures

KW - Cardiotonic Agents/therapeutic use

KW - Child

KW - Humans

KW - Hydrazones

KW - Infant

KW - Milrinone

KW - Prospective Studies

KW - Pyridazines

KW - Simendan

U2 - 10.1053/j.jvca.2020.02.027

DO - 10.1053/j.jvca.2020.02.027

M3 - Article

C2 - 32201198

SN - 1053-0770

VL - 34

SP - 2072

EP - 2080

JO - J Cardiothorac Vasc Anesth

JF - J Cardiothorac Vasc Anesth

IS - 8

ER -

Levosimendan Versus Milrinone for Inotropic Support in Pediatric Cardiac Surgery: Results From a Randomized Trial

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