The Effect of Inhaled Milrinone Versus Inhaled Levosimendan in Pulmonary Hypertension Patients Undergoing Mitral Valve Surgery — A Pilot Randomized Double-Blind Study

• Published in: Journal of cardiothoracic and vascular anesthesia 2018-10, Vol.32 (5), p.2123-2129
• Main Authors: Kundra, Tanveer Singh, Prabhakar, V., Kaur, Parminder, Manjunatha, N., Gandham, Ravi
• Format: Article
• Language: English
• Subjects: Administration, Inhalation; Adult; Blood Pressure - drug effects; Cardiotonic Agents - administration & dosage; Dose-Response Relationship, Drug; Double-Blind Method; Female; Follow-Up Studies; Heart Valve Diseases - complications; Heart Valve Diseases - physiopathology; Heart Valve Diseases - surgery; Humans; Hypertension, Pulmonary - etiology; Hypertension, Pulmonary - physiopathology; Hypertension, Pulmonary - therapy; inhalation; levosimendan; Male; milrinone; Milrinone - administration & dosage; Mitral Valve - surgery; Pilot Projects; Prospective Studies; pulmonary artery pressure; pulmonary hypertension; Pulmonary Wedge Pressure - drug effects; Simendan - administration & dosage; systemic vascular resistance; Treatment Outcome; Vascular Resistance - drug effects
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2018.04.022

To compare the effects of inhaled milrinone and levosimendan on pulmonary and systemic hemodynamics in patients with pulmonary hypertension. Prospective, double-blind, randomized controlled study. Tertiary care cardiac institute with 650 beds. The study comprised 150 adult patients with pulmonary hypertension undergoing mitral valve surgery. Patients were assigned randomly into 1 of the following 3 groups: milrinone (M), levosimendan (L), or control (C); n = 50 per group. In group M, inhaled milrinone (50 µg/kg); in group L, inhaled levosimendan (24 µg/kg); and in group C, normal saline was administered when the patient arrived in the recovery room. Pre-inhalation and post-inhalation hemodynamics (mean arterial pressure [MAP], pulse rate, and systemic vascular resistance [SVR]) were noted until 24 hours of inhalation of the drug. The change in pulmonary artery pressures (pulmonary artery systolic pressure [PASP] and mean pulmonary artery pressure [MPAP]) and the duration for which they remained decreased compared with the control group, were noted. MAP, pulse rate, and SVR were comparable in the 3 groups at various time intervals. PASP and MPAP decreased comparably after inhalation of levosimendan and milrinone. However, they reached levels near the control group values after 2.5 to 3 hours in group L and after 0.5 hours in group M. Because inhaled levosimendan causes a decrease in PASP and MPAP without causing a decrease in SVR and MAP, the authors conclude that inhaled levosimendan is a selective pulmonary vasodilator. It is as effective as milrinone in reducing pulmonary artery pressures. In addition, it has advantage over inhaled milrinone because it is has a longer duration of action.