Aim:
Although conventional inotropic drugs are well examined for myocardial support during weaning from cardiopulmonary bypass (CPB), there is limited experience about a new calcium sensitiser drug, levosimendan. We aimed to investigate effects of early infusion of ‘levosimendan’ started per-operatively without a loading dose, on outcomes of patients experiencing difficultly to wean from CPB after coronary artery bypass grafting (CABG).
Material and Methods:
Forty two consecutive patients undergoing CABG with high Euroscores (>6) were included in the study. Patients received levosimendan at a rate of 0.1 mcg/kg/min (without a loading dose) per-operatively for 24 h. All patients also received dopamine (5-15 mcg/kg/min), 39 patients adrenaline (0.03-0.2 mg/kg/min) and 9 patients were additionally administered dobutamine (6-20 mcg/kg/min). Intra-aortic balloon pump was implanted to four patients who failed to wean from CPB. Pre- and post-operative demographic, echocardiographic and hemodynamic parameters, as well as operative data were analysed.
Results:
Mean patient age was 61.36±9.1 years (min:39, max:77). Mean extubation time of patients was 18.34±6.2 hours (min:9, max:34) and mean surgical intensive care unit stay was 5.45±2.3 days (min:1, max:15). In comparison to the pre-operative measurements patients showed statistically significant increase of left ventricle ejection fraction (LVEF) and decrease of left atrial, left ventricular end diastolic and right ventricular end diastolic diameters following levosimendan administration in the post-operative period. Increase of pro-BNP level on the 3rd postoperative day was also statistically significant (p=0.047). However, pro-BNP levels on the post-operative 6th month was not significantly different from pre-operative levels (p=0.4). Heart rate and invasive systolic and diastolic blood pressure levels were recorded at 23rd hour of perfusion and compared with those of 1 hour after its cessation. Although heart rate remains almost constant (p=0.13), increase in systolic and diastolic blood pressures was markedly statistically significant (p=0.0001).
Conclusion:
Levosimendan appears to be an efficient drug if used in addition to conventional inotropics for the management of low cardiac output syndrome states before, during or after on-pump cardiac surgery.
Keywords: Coronary Artery Bypass Grafting, Low cardiac output, Levosimendan, Cardioprotective Agents, Euroscore
