Intravenous Levosimendan versus Milrinone: Coronary Sinus Lactate and PA Catheter Derived Parameters in Patients with Pulmonary Hypertension Undergoing Elective Mitral Valve Replacement
Abstract
Background: Coronary sinus (CS) lactate level has been shown to corroborate with changes in myocardial metabolism induced by ischaemia and reperfusion, and hence can be used to indicate the effect on myocardial metabolism. In patients with mitral stenosis (MS) undergoing valvuloplasty or valve replacement, presence of severe pulmonary hypertension (PH), indicates advanced disease state and development of right ventricular (RV) failure, an important hallmark of bad prognosis. Levosimendan and milrinone are increasingly being used as inodilators to treat PH and improve RV function to varying degrees, but their effect on myocardial metabolism awaits precise validation.
Methods: Thirty patients were randomized into two groups of 15 patients each. Group L (received levosimendan) and Group M (received milrinone). All the patients received fentanyl (8-10 μg/kg), rocuronium bromide 0.8 mg/Kg for induction and maintenance of anaesthesia. In addition to the routine intravenous and invasive arterial access, a Cavafix® (Certo® 257, 45 cm, B Braun Melsungen AG, Germany) was inserted via right IJV and positioned in the right atrium (RA) to be later re-positioned in the CS before coming off cardiopulmonary bypass (CPB), to obtain blood samples for measuring the CS lactate levels postoperatively. At the commencement of rewarming, group L received levosimendan 10 μ/kg bolus over 10 min, followed by an infusion (0.1 μ/kg/min) and group M received 50 μg/kg bolus over 10 min, followed by…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 15 participants or records.
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