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The effects of levosimendan in patients undergoing transcatheter aortic valve replacement- a retrospective analysis

Zhenyan Zhao1, Zhen Meng1,2, Guangyuan Song3

  • 1State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.

Frontiers in Pharmacology
|November 21, 2022
PubMed

Insights

Prophylactic levosimendan after transcatheter aortic valve replacement (TAVR) did not lower mortality but significantly reduced stroke or heart failure (HF) hospitalizations. This finding suggests a potential benefit for post-TAVR patients receiving this inotropic agent.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Pharmacology

Background:

  • Aortic stenosis (AS) increases left ventricular afterload, potentially causing cardiac damage and heart failure (HF).
  • Transcatheter aortic valve replacement (TAVR) is a primary treatment for severe AS.
  • The role of inotropic agents, such as levosimendan, in patients undergoing TAVR remains unevaluated.

Purpose of the Study:

  • To evaluate the efficacy of prophylactic levosimendan administration immediately after TAVR.
  • To assess the impact of levosimendan on 2-year all-cause mortality, stroke, and HF-related hospitalizations in TAVR patients.

Main Methods:

  • A cohort of 210 patients undergoing TAVR between 2014-2019 was analyzed.
  • 105 patients received levosimendan (0.1 μg/kg/min) post-procedure, compared to a control group.
  • Outcomes were analyzed using Cox proportional hazard models, focusing on mortality, stroke, and HF hospitalizations.

Main Results:

  • Levosimendan did not significantly alter 2-year all-cause mortality compared to the control group (HR: 0.603, p=0.375).
  • A significant reduction was observed in stroke or HF-related hospitalizations (HR: 0.346, p=0.027) and a combined endpoint (HR: 0.459, p=0.044) in the levosimendan group.
  • Adjusted analysis confirmed levosimendan's benefit in reducing stroke or HF-related hospitalizations (HR: 0.346, p=0.038).

Conclusions:

  • Prophylactic levosimendan administration post-TAVR is associated with a reduced risk of stroke or HF-related hospitalizations.
  • Levosimendan does not appear to impact all-cause mortality in patients undergoing TAVR.
  • These findings suggest a potential therapeutic role for levosimendan in managing post-TAVR complications.

Keywords:
aortic stenosisheart failureinotropelevosimendantranscatheter valve replacement

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