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

Zhenyan Zhao; Zhen Meng; Guangyuan Song; Chunrong Wang; Sheng Shi; Jie Zhao; Hongliang Zhang; Moyang Wang; Guannan Niu; Zheng Zhou; Jianhui Wang; Yongjian Wu

doi:10.3389/fphar.2022.969088

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

Front Pharmacol. 2022 Nov 3:13:969088. doi: 10.3389/fphar.2022.969088. eCollection 2022.

Authors

Zhenyan Zhao¹, Zhen Meng^{1

2}, Guangyuan Song³, Chunrong Wang⁴, Sheng Shi⁴, Jie Zhao¹, Hongliang Zhang¹, Moyang Wang¹, Guannan Niu¹, Zheng Zhou¹, Jianhui Wang⁴, Yongjian Wu¹

Affiliations

¹ State 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.
² Department of Cardiology, China-Japan Friendship Hospital, Beijing, China.
³ Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
⁴ Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Abstract

Background: Aortic stenosis (AS) increases left ventricular afterload, leading to cardiac damage and heart failure (HF). Transcatheter aortic valve replacement (TAVR) is an effective therapy for AS. No inotropic agents including levosimendan have been evaluated in patients undergoing TAVR. Methods: A total of 285 patients underwent TAVR between 2014 and 2019; 210 were included in the matched analysis and 105 received 0.1 μg/kg body weight/min levosimendan immediately after the prosthesis had been successfully implanted. Medical history, laboratory tests, and echocardiography results were analyzed. Endpoints including 2-year all-cause mortality, stroke, or HF-related hospitalization, and a combination of the above were analyzed by Cox proportional hazard models. Results: The levosimendan group had no difference in 2-year mortality compared with the control group (hazard ratio [HR]: 0.603, 95% confidence interval [CI]: 0.197-1.844; p = 0.375). However, levosimendan reduced stroke or HF-related hospitalization (HR: 0.346; 95% CI: 0.135-0.884; p = 0.027) and the combined endpoint (HR: 0.459, 95% CI: 0.215-0.980; p = 0.044). After adjusting for multiple variants, levosimendan still reduced stroke or HF-related hospitalization (HR: 0.346, 95% CI: 0.134-0.944; p = 0.038). Conclusion: Prophylactic levosimendan administration immediately after valve implantation in patients undergoing TAVR can reduce stroke or HF-related hospitalization but does not lower all-cause mortality.

Keywords: aortic stenosis; heart failure; inotrope; levosimendan; transcatheter valve replacement.