Objective To observe the safety and efficacy of levosimendan in the perioperative period for patients with pulmonary hypertension associated with valvular heart disease undergoing heart valve replacement surgery.

Methods A total of 90 patients with pulmonary hypertension associated with valvular heart disease who underwent valve replacement surgery from April 2023 to May 2024 were enrolled. Based on the use of levosimendan, patients were divided into low-dose group, high-dose group, and control group, with 30 patients in each group. The control group received conventional drug therapy; the low-dose group received one dose of levosimendan from 3 days before surgery to 3 days after surgery combined with conventional drug therapy; the high-dose group received two doses of levosimendan from 3 days before surgery to 3 days after surgery combined with conventional drug therapy. Data on brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), creatinine (Cr), mean pulmonary artery pressure (mPAP), PH related to left heart disease (PH-LHD) status, postoperative ICU stay, postoperative hospital stay, and cardiac function classification were collected and recorded at admission and before discharge.

Results There were no statistically significant differences in gender, age, and body mass among the control group, low-dose group, and high-dose group (P>0.05). There was no statistically significant difference in the increase in Cr among the three groups (P>0.05). There were statistically significant differences in postoperative ICU stay between the control group and the high-dose group, and between the control group and the low-dose group (P=0.017, 0.028). However, there was no statistically significant difference in postoperative ICU stay between the low-dose group and the high-dose group (P=0.839). There were statistically significant differences in postoperative hospital stay between the control group and the high-dose group, and between the control group and the low-dose group (P=0.001, 0.009), but no statistically significant difference was found between the low-dose group and the high-dose group (P=0.463). No serious complications occurred in any of three groups, and no patients withdrew from the study. Only one patient in the high-dose group experienced hypotension during the postoperative use of levosimendan, which normalized after fluid replacement. There was no statistically significant difference in the decrease in mPAP among the three groups (P>0.05). There was a statistically significant difference in the decrease in BNP between the control group and the high-dose group (P=0.025); however, there were no statistically significant differences in the decrease in BNP between the control group and the low-dose group, or between the low-dose group and the high-dose group (P=0.068, 0.970). There was a statistically significant difference in the increase in LVEF between the control group and the high-dose group (P=0.019); however, there were no statistically significant differences in the increase in LVEF between the control group and the low-dose group, or between the low-dose group and the high-dose group (P=0.055, 0.652). There were statistically significant differences in the decrease in LVEDD between the control group and the low-dose group, and between the control group and the high-dose group (P=0.019, 0.033); however, there was no statistically significant difference between the low-dose group and the high-dose group (P=0.829). In the control group, 18 patients (60.0%) had clinically effective treatment, 22 patients (73.3%) in the low-dose group, and 24 patients (80.0%) in the high-dose group. There was no statistically significant difference in clinical efficacy among the three groups (P=0.220).

Conclusion Levosimendan is safe and effective in the perioperative period for patients with pulmonary hypertension associated with valvular heart disease, and high-dose use can more significantly improve LVEF and reduce BNP levels.