Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 2010 , Vol 1, Issue 1
Preoperative Use of Levosimendan In Cardiac Surgery Patients With Heart Failure Due To Severe Left Ventricular Dysfunction
Şahin Şenay1, Fevzi Toraman2, Sinan Dağdelen3, Hasan Karabulut1, Cem Alhan1
1Acıbadem Üniversitesi Tıp Fakültesi, Kalp ve Damar Cerrahisi Anabilim Dalı, İstanbul, Türkiye
2Acıbadem Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, İstanbul, Türkiye
3Acıbadem Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, İstanbul, Türkiye
Objectives: We aimed to evaluate the clinical and hemodynamic eff ects of preoperative use of levosimendan in cardiac surgery patients with severe left ventricular dysfunction.

Study design: Ten patients with poor ventricular function (EF ≤30%) undergoing cardiac surgery with cardiopulmonary bypass (CPB) were prospectively enrolled. Patients received levosimendan infusion of 0.1 mcg/kg/min, starting 4 hours before the surgical procedure to be continued for 24 hours. Measurements of ejection fraction were performed preoperatively and postoperatively on the 5th day and 1st month. Cardiac index, pulmonary capillary wedge pressure, systemic vascular resistance index, pulmonary vascular resistance index, mean arterial pressure, central venous pressure, mean pulmonary artery pressure was monitored at the postoperative 0th, 4th, 6th, 12th and 24th hours.

Results: All the patients underwent coronary bypass surgery; one patient had aortic valve replacement, one had tricuspid valve repair, one had mitral valve repair and one had left ventricular aneurysmectomy additionally. Mean Euroscore of the group was 6.5±2.7. No postoperative IABP use, stroke, renal failure, major infection and 1 month mortality were observed. Pulmonary vascular resistance was significantly reduced (p =0.001) postoperatively. Mean follow up period was 11.6± 5.7 month (range: 4–17 month). No late mortality or cardiac reintervention was observed. The ejection fraction at the preoperative, postoperative 1st day and postoperative 1st month were as 27.5±3.1; 37.1±5.4; 40.3±10.7 (%) respectively (p=0.01).

Conclusion: Early use of levosimendan prior to the cardiac operation in patients with heart failure due to poor left ventricular function may improve hemodynamic function and clinical outcome. Keywords : ventricular dysfunction, cardiac surgery