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Background: As the burden of cardiovascular disease grows, so does the number of cardiac surgeries. Surgery is increasingly performed on older people with comorbidities who are at higher risk of developing perioperative complications such as low cardiac output state (LCOS). Surgery-associated LCOS represents a serious pathology responsible for substantial morbidity and mortality.

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Hemodynamic management of acute kidney injury.

Curr Opin Crit Care

December 2024

Department of Anesthesiology, Intensive Care & Perioperative Medicine, Assistance Publique Hôpitaux de Paris. Paris Saclay University, Paris, France.

Purpose Of Review: To discuss the role of hemodynamic management in critically ill patients with acute kidney injury.

Recent Findings: Acute kidney injury (AKI) may be associated with persistent alterations in renal perfusion, even when cardiac output and blood pressure are preserved. The effects of interventions aiming at increasing renal perfusion are best evaluated by renal Doppler or contrast enhance ultrasound.

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Objective: To test the hypothesis that levosimendan administration in patients with low cardiac output syndrome after cardiac surgery is associated with improved long-term (5-year follow-up) outcomes.

Design: Single-center subanalysis of the multicenter randomized CHEETAH trial.

Setting: Cardiac surgery department of a tertiary hospital.

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The perioperative management of patients with pulmonary hypertension (PH) undergoing cardiac surgery is challenging, mainly due to the potential risk of right ventricular failure (RVF). Levosimendan is a calcium-sensitizing agent that has primarily been used in the treatment of decompensated heart failure. However, recently levosimendan has been shown to be an effective and safe therapeutic strategy for patients with pulmonary arterial hypertension and PH associated with left heart disease.

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Article Synopsis
  • * Levosimendan, a novel calcium sensitizer, is used during heart valve surgeries to enhance long-term patient outcomes and reduce postoperative mortality, especially in those with heart function issues.
  • * A case study highlights a 62-year-old woman with multiple health issues who underwent successful tricuspid valve and atrial septal defect repair, benefiting from levosimendan to shorten her recovery time in intensive care.
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