Preoperative optimization with levosimendan in heart failure patient undergoing thoracic surgery

Moana Rossella Nespoli; Marco Rispoli; Dario Maria Mattiacci; Marianna Esposito; Antonio Corcione; Carlo Curcio; Salvatore Buono

doi:10.1016/j.ijscr.2016.08.003

Preoperative optimization with levosimendan in heart failure patient undergoing thoracic surgery

Int J Surg Case Rep. 2016:27:1-4. doi: 10.1016/j.ijscr.2016.08.003. Epub 2016 Aug 4.

Authors

Moana Rossella Nespoli¹, Marco Rispoli², Dario Maria Mattiacci³, Marianna Esposito¹, Antonio Corcione⁴, Carlo Curcio⁴, Salvatore Buono⁵

Affiliations

¹ Anesthesia and Intensive Care, AORN dei Colli Vincenzo Monaldi Hospital, Naples, Italy.
² Anesthesia and Intensive Care, AORN dei Colli Vincenzo Monaldi Hospital, Naples, Italy. Electronic address: marco-rispoli@hotmail.it.
³ Anesthesia and Intensive Care, AORN dei Colli Vincenzo Monaldi Hospital, Naples, Italy. Electronic address: dario.mattiacci@libero.it.
⁴ Thoracic Surgery, AORN dei Colli Vincenzo Monaldi Hospital, Naples, Italy.
⁵ Thoracic Surgery, AORN dei Colli Vincenzo Monaldi Hospital, Naples, Italy. Electronic address: mauro97@libero.it.

Abstract

Introduction: We present the case of a patient with dilatative cardiomyopathy waiting for heart transplantation with pleural effusion to be subjected to pleural biopsy, treated with preoperative infusion of levosimendan to improve heart performances.

Presentation of case: A 56-year-old man (BMI 22,49) with dilatative cardiomyopathy (EF 18%) presented right pleural effusion. The levosimendan treatment protocol consisted of 24h continuous infusion (0,1ug/kg/min), without bolus. The patient was under continuous hemodynamic monitoring prior, during and after levosimendan administration. The surgery for pleural biopsy was performed with uniportal Video Assisted Thoracoscopic approach (VATS).

Discussion: A significant increase of Cardiac Index (CI) and Stroke Volume Index (SVI) were observed at 4h after infusion initiation and was sustained during the next 24h after the end of infusion. Levosimendan administration was safe.

Conclusion: In this case the prophylactic preoperative levosimendan administration is safe and effective in cardiac failure patient undergoing thoracic surgery, but prophylactic preoperative levosimendan treatment in these patients merits further study.

Keywords: Heart failure patient; Levosimendan; Preoperative optimization; Thoracic surgery.