Effects of levosimendan started 24 hours before cardiopulmonary bypass in patients admitted to the ICU with an ejection fraction lower than 30%

Abstract

Introduction: Patients with poor left ventricular function require inotropic drug support after cardiopulmonary bypass (CPB). The use of levosimendan in these patients is associated with a better postoperative function [1]. A recent study has attributed this phenomenon to preconditioning effects of levosimendan [2]. However, a recent study showed no benefit in starting levosimendan before CPB [3]. We hypothesized that admitting the patient to intensive care 24 hours before CPB and starting levosimendan preoperatively could reduce postoperative cardiac damage. Methods: Fifty patients with an ejection fraction less than 30% scheduled for elective cardiac surgery with CPB received anesthesia with propofol, cisatracurium and sufentanil. The patients were randomly assigned to two protocols. Group A: levosimendan 0.1 μg/kg/minute started before CPB after induction + dobutamine 5 μg/kg/minute started after the release of the Aox. Group B: levosimendan 0.1 μg/kg/minute started on the ICU 24 hours before CPB + dobutamine 5 μg/kg/minute started after the release of the Aox. Data analysis: SV, dobutamine, noradrenaline time and dose, cardiac enzymes, global hemodynamic variables, ICU and hospital length of stay. Statistical significance was accepted at P 0.05. Results: There was no difference in postoperative stroke volume and troponin I. The incidence of postoperative atrial fibrillation in both groups was very low. There was a significant difference in ICU length of stay but not in hospital length of stay. Conclusions: In cardiac surgery patients with a low preoperative ejection fraction there is no difference in cardiac function and postoperative troponin I levels between the two different levosimendan treatment modalities. The incidence of postoperative atrial fibrillation is low when levosimendan is used perioperatively. There is a significant reduction in the ICU length of stay, but not in the hospital length of stay.