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Cardiac, renal, and neurological benefits of preoperative levosimendan administration in patients with right ventricular dysfunction and pulmonary hypertension undergoing cardiac surgery: evaluation with two biomarkers neutrophil gelatinase-associated lipocalin and neuronal enolase.

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2016-04-21

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Guerrero-Orriach, José Luis
Ariza-Villanueva, Daniel
Florez-Vela, Ana
Garrido-Sánchez, Lourdes
Moreno-Cortés, María Isabel
Galán-Ortega, Manuel
Ramírez-Fernández, Alicia
Alcaide Torres, Juan
Fernandez, Concepción Santiago
Navarro Arce, Isabel

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Dovepress
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Abstract

To evaluate if the preoperative administration of levosimendan in patients with right ventricular (RV) dysfunction, pulmonary hypertension, and high perioperative risk would improve cardiac function and would also have a protective effect on renal and neurological functions, assessed using two biomarkers neutrophil gelatinase-associated lipocalin (N-GAL) and neuronal enolase. This is an observational study. Twenty-seven high-risk cardiac patients with RV dysfunction and pulmonary hypertension, scheduled for cardiac valve surgery, were prospectively followed after preoperative administration of levosimendan. Levosimendan was administered preoperatively on the day before surgery. All patients were considered high risk of cardiac and perioperative renal complications. Cardiac function was assessed by echocardiography, renal function by urinary N-GAL levels, and the acute kidney injury scale. Neuronal damage was assessed by neuron-specific enolase levels. After surgery, no significant variations were found in mean and SE levels of N-GAL (14.31 [28.34] ng/mL vs 13.41 [38.24] ng/mL), neuron-specific enolase (5.40 [0.41] ng/mL vs 4.32 [0.61] ng/mL), or mean ± SD creatinine (1.06±0.24 mg/dL vs 1.25±0.37 mg/dL at 48 hours). RV dilatation decreased from 4.23±0.7 mm to 3.45±0.6 mm and pulmonary artery pressure from 58±18 mmHg to 42±19 mmHg at 48 hours. Preoperative administration of levosimendan has shown a protective role against cardiac, renal, and neurological damage in patients with a high risk of multiple organ dysfunctions undergoing cardiac surgery.

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MeSH Terms

Simendan
Creatinine
Hypertension, Pulmonary
Lipocalin-2
Pulmonary Artery
Multiple Organ Failure
Cardiac Surgical Procedures
Echocardiography
Acute Kidney Injury

DeCS Terms

Simendán
Cirugía General
Fosfopiruvato Hidratasa
Hipertensión Pulmonar
Arteria Pulmonar
Creatinina
Lesión Renal Aguda
Ecocardiografía
Válvulas Cardíacas
Lipocalina 2
Cirugía Torácica

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Keywords

acute renal failure, brain, kidney, levosimendan, preoperative

Citation

Guerrero-Orriach JL, Ariza-Villanueva D, Florez-Vela A, Garrido-Sánchez L, Moreno-Cortés MI, Galán-Ortega M, et al. Cardiac, renal, and neurological benefits of preoperative levosimendan administration in patients with right ventricular dysfunction and pulmonary hypertension undergoing cardiac surgery: evaluation with two biomarkers neutrophil gelatinase-associated lipocalin and neuronal enolase. Ther Clin Risk Manag. 2016;12:623-630. Published 2016 Apr 21.