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

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: acute renal failure; brain; kidney; levosimendan; preoperative.

Figure 1

Preoperative and postoperative N-GAL values. Notes: The scatter graph shows N-GAL values before and after surgery in 27 patients preoperatively administered levosimendan and the mean of the N-GAL concentration in urine at these two time points. Preop was the preoperative values (before levosimendan) and postop was postoperative values (2 hours after ICU admission postsurgery). Mean values were 14.31 ng/mL prior to levosimendan infusion and 13.41 ng/mL 2 hours after ICU admission. The variations were not statistically significant (P>0.05). Abbreviations: N-GAL, neutrophil gelatinase-associated lipocalin; ICU, intensive care unit.

Figure 2

Preoperative and postoperative neuron-specific enolase values. Notes: The scatter graph shows neuron-specific enolase values before and after surgery in 27 patients preoperatively administered levosimendan and the medians of neuron-specific enolase concentrations in urine at these two time points. Preop was the preoperative values (before levosimendan) and postop was postoperative values (2 hours after ICU admission postsurgery). The median values were 5.4 ng/mL prior to levosimendan infusion and 4.32 ng/mL 2 hours after ICU admission. The variations were not statistically significant (P>0.05). Abbreviation: ICU, intensive care unit.