Levosimendan In Patients Undergoing LVAD Implantation

University Hospital Dubrava

Status: Unknown

Conditions: Right Ventricular Dysfunction; Left Ventricular Dysfunction; Biventricular Failure

Treatments: Drug: Levosimendan 2.5 MG/ML Injectable Solution

Study type: Observational

Funder types: Other

Identifiers

NCT03659851

UH Dubrava

Details and patient eligibility

About

According to the results from the literature, it has been shown that levosimendan usage 24-48 hours before LVAD implementation can improve short and long-term outcome in these patients regarding to the patients without preoperative pretreatment. The aim is to compare short and long-term outcome in patients who underwent to LVAD implementation and pretreated with levosimendan regarding the patient without pretreatment or with other medications.

Full description

Left ventricular assist device (LVAD) implantation is accepted for treatment of end-stage heart failure, in both as the bridging to heart transplantation or as the destination therapy. These patients have highly impaired systolic function which contributes to global heart dysfunction. The main complication is arising of pulmonary vascular pressures and pulmonary vascular resistance (PVR) and, consequently, right heart dysfunction. From the data in literature, RV dysfunction exist in approximately 25%-40% of patients with implanted LVAD, and in approximately 20%-30% of those died or have need for the RV assist device due to RV failure refractory to medications. Capability of the RV to maintain appropriate output and the fill of the LVAD is the main point for correct LVAD functioning and patients' early and late postoperative outcome. Preimplantation evaluation by echocardiography estimation of RV function, geometry and tricuspid valve function are the criteria for the diagnose of RV dysfunction. Laboratory analysis which can lead to the diagnose of RV dysfunction are also included in preimplantation evaluation. Specific inotropic therapy in patients with moderate or severe RV dysfunction and/or dilatation can improve RV function in preimplantation period. This is predominantly important in patients who were on the prolonged inotropic support with beta-agonist therapy before LVAD implantation and in whom their beta receptors are exhausted. The investigators will exam the hemodynamic effects of levosimendan administrated day before in patients underwent LVAD implantation. Further, investigators will analyze and evaluate early and late outcome in participants with implanted LVAD.

Enrollment: 50 estimated patients

Sex: All

Ages: 18 to 70 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• All patients scheduled for LVAD implantation

Exclusion criteria

• Known patient's allergy on medication
• Patient's disagreement for the procedure

Trial design

50 participants in 2 patient groups

Levosimendan before LVAD implantation

Description:

Levosimendan use 24 hrs. before LVAD implantation

Treatment:

Drug: Levosimendan 2.5 MG/ML Injectable Solution

Dobutamine/milrinone before LVAD implantation

Description:

Dobutamine/milrinone use 24 hrs. before LVAD implantation