A levoszimendán perioperatív alkalmazása a szívsebészetben. Magyar ajánlás

Low output syndrome significantly increases morbidity and mortality of cardiac surgery and lengthens the durations of intensive care unit and hospital stays. Its treatment by catecholamines can lead to undesirable systemic and cardiac complications. Levosimendan is a calcium sensitiser and adenosine triphosphate (ATP)-sensitive potassium channel (IK,ATP) opener agent. Due to these effects, it improves myocardium performance, does not influence adversely the balance between O2 supply and demand, and possesses cardioprotective and organ protective properties as well. Based on the scientific literature and experts’ opinions, a European recommendation was published on the perioperative use of levosimendan in cardiac surgery in 2015. Along this line, and also taking into consideration cardiac surgeon, anaesthesiologist and cardiologist representatives of the seven Hungarian heart centres and the children heart centre, the Hungarian recommendation has been formulated that is based on two pillars: literature evidence and Hungarian expert opinions. The reviewed fields are: coronary and valvular surgery, assist device implantation, heart transplantation both in adult and pediatric cardiologic practice. Orv Hetil. 2018; 159(22): 870–877.

Perioperative use of levosimendan in cardiac surgery

<div data-canvas-width="623.7918644546122">It is known that low cardiac output in patients undergoing cardiac surgery is associated with organ dysfunction and mortality in the postoperative period. Catecholamines have been the standard therapy for many years, although they carry substantial risks for adverse cardiac and systemic effects, and have been reported to be associated with increased mortality. On the other hand, the calcium sensitiser and potassium channel opener levosimendan has been shown to improve the cardiac function with</div><div data-canvas-width="623.8018800588713">no imbalance in oxygen consumption, and to have protective effects in other organs. Several clinical trials have found beneficial effects of cardiogenic and non-cardiogenic perioperative use of levosimendan. The aim of this article was to describe the mechanism of levosimendan action, as well as to overview the current data regarding its clinical application.</div><div data-canvas-width="623.8018800588713"><span><br /></span></div><div data-canvas-width="623.8018800588713"><span>Received 22 April 2015. Accepted 18 June 2015.</span></div><div data-canvas-width="311.3250427845475"> </div><div data-canvas-width="311.3250427845475"> </div>

Myocardial Depression Associated with Pneumococcal Septic Shock Reversed by Levosimendan

Levosimendan is a myocardial calcium sensitiser and potassium-ATP channel opener. Levosimendan has been used in critically ill patients in various conditions to support myocardial function as an inotrope, lusitrope and vasodilator. We report the use of levosimendan in a patient with invasive streptococcal septic shock.