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

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.

Conclusion

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.

References

  1. 1.

    De Hert SG: Anesth Analg. 2007, 104: 766-773. 10.1213/01.ane.0000256863.92050.d3

  2. 2.

    Tritapepe L: Br J Anaesth. 2006, 96: 694-700. 10.1093/bja/ael082

  3. 3.

    De Hert SG, et al.: J Cardiothorac Vasc Anesth. 2008, 22: 699-705. 10.1053/j.jvca.2008.02.019

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Duchateau, J., Eede, H.V. Effects of levosimendan started 24 hours before cardiopulmonary bypass in patients admitted to the ICU with an ejection fraction lower than 30%. Crit Care 13, P167 (2009). https://doi.org/10.1186/cc7331

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Keywords

  • Dobutamine
  • Sufentanil
  • Hospital Length
  • Levosimendan
  • Cisatracurium