Arq. Bras. Cardiol. 2023; 120(2): e20220205
Outpatient 6-Hour Levosimendan Treatment as a Bridge to Heart Transplant
António Valentim Gonçalves
, João Pedro Reis
, Ana Teresa Timóteo
, Rui Soares, Tiago Pereira-da-Silva, Valdemar Gomes, Rita Ilhão Moreira
, Delmira Pombo, Tiago Carvalho, Catarina Correia, Claudia Santos, Rui Cruz Ferreira
Heart transplantation is the treatment of choice for selected patients with advanced heart failure (HF), improving quality of life and conferring a survival benefit compared to conventional management. However, heart transplantation depends on a donor’s presence, necessitating bridge strategies. Infusion of inotropes was suggested as one of these treatments, but a meta-analysis of randomized trials found increased mortality with long-term inotropic support, and HF guidelines do not now endorse this strategy.
The inodilator Levosimendan has arisen as a treatment option: its inotropic action can continue for up to 2 weeks while being less pro-arrhythmic than traditional inotropes. It was traditionally administered as a 24-hour infusion. Nonetheless, a 24-hour infusion necessitates at least a two-day stay in the hospital. Recently, two randomized placebo-controlled, double-blind clinical trials evaluated 6-hour cycles of Levosimendan therapy in ambulatory patients with advanced HF and demonstrated that it reduces NT-proBNP levels and admissions for acute decompensated HF. ,
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