Levosimendan in cardiac surgery

Background

Levosimendan is a new calcium sensitizer with inodilatory properties. The aim of this case series report was to evaluate the effects of perioperative and postoperative use of levosimendan in cardio-surgical patients with high perioperative risk, compromised left ventricular (LV) function or with difficulties in weaning from the cardiopulmonary bypass (CPB).

Methods

Sixteen cardio-surgical patients received levosimendan infusion with a maximum duration of 29 hours. Eight infusions were initiated preoperatively and eight postoperatively. Most patients received 0.1 μg/kg/min levosimendan after a bolus of 12–24 μg/kg for 10 min. The main operative indication was coronary artery disease. Seventy-five per cent of the subjects were high-risk patients. Because of cardiac pacing postoperatively, the heart rate was not analysed.

Results

Continuous infusion of levosimendan increased the cardiac index in both groups significantly. The pulmonary capillary wedge pressure and systolic blood pressure did not change. Crystalloids and vasopressors, most commonly noradrenaline and adrenaline, were administered as needed. Weaning from CPB was successful in all the patients. Two of the infusions were discontinued due to hypotension. One high-risk patient in the preoperative group died during the operation. In the postoperative group, two patients with multiorgan failure died postoperatively.

Conclusions

Levosimendan can safely and effectively be used in high-risk cardio-surgical patients. Compared with the high risk of the patients, the mortality remained rather low. In addition to administering levosimendan as postoperative rescue therapy for patients with difficult weaning from CPB, an elective initiation of levosimendan preoperatively seems to be beneficial for patients with high perioperative risk or compromised LV function.