Effect of levosimendan infusion prior to LVAD implantation

Introduction: Data on the safety and efficacy of preoperative levosimendan infusion in patients undergoing LVAD implantation is scarce. Our objective was to investigate the clinical utility of preoperative levosimendan administration in patients awaiting LVAD implantation.

Methods: A retrospective analysis of all consecutive patients who received continuous-flow LVADs (HeartMate 2, 3, and HVAD) between August 2012 and May 2018 at the Sheba Medical Center. INTERMACS profile 1 patients were excluded. Patients who received preoperative levosimendan were compared to patients who did not receive levosimendan preoperatively.

Results: The study cohort consisted of 62 patients (40 [65%] in the levosimendan group and 22 [35%] in the no-levosimendan group) with a median follow-up of 21 months.
Preoperative laboratory, hemodynamic, and echocardiographic parameters were similar in both groups except for lower median albumin levels (3.7 g/dL vs. 4 g/dL; P=0.024) and higher median pre-capillary wedge pressure (28 mmHg vs. 23.5 mmHg; P=0.047) among patients in the levosimendan group.
No patient in either group required right ventricular assist device support. There was no difference in post-operative inotropes and ventilation support time between the levosimendan and no-levosimendan groups (median of 51 hours vs. 72 hours; P=0.41 and 24 hours vs. 27 hours; P=0.19, respectively). Length of hospitalization, both total and in the intensive care unit was similar (median of 13 days vs. 16 days; P=0.34, and 3 days vs. 4 days; P=0.44, respectively).
Post-operative laboratory and echocardiographic parameters did not differ between the groups. The in-hospital complication rate including bleeding, surgical re-exploration and cardiac arrhythmias were also similar.
There was no significant difference in the in-hospital and long term mortaity throughout the follow-up period between the groups (2.5% vs. 4.5%; P>0.999 and 10% vs. 27.3% respectively; P = 0.64).

Conclusion: Levosimendan infusion prior to LVAD implantation was not associated with improved post-operative outcomes.