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CARDIOVASCULAR ANESTHESIA

The Effects of Levosimendan in Cardiac Surgery Patients with Poor Left Ventricular Function

Stefan G. De Hert, MD, PhD^*, Suraphong Lorsomradee, MD^*, Stefanie Cromheecke, MD^*, and Philippe J. Van der Linden, MD, PhD

From the *Department of Anesthesiology, University of Antwerp, University Hospital Antwerp, Belgium; and Department of Anesthesiology, CHU Brugmann HUDERF, Brussels, Belgium.

Address correspondence and reprint requests to Stefan G. De Hert, MD, PhD, Department of Anesthesiology, University Hospital Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium. Address e-mail to stefan.dehert{at}ua.ac.be.

BACKGROUND: Patients with poor left ventricular function often require inotropic drug support immediately after cardiopulmonary bypass. Levosimendan improves cardiac function by a novel mechanism of action compared to currently available drugs. We hypothesized that, in patients with severely compromised ventricular function, the use of levosimendan would be associated with better postoperative cardiac function than with inotropic drugs that increase myocardial oxygen consumption.

METHODS: Thirty patients with a preoperative ejection fraction 30% scheduled for elective cardiac surgery with cardiopulmonary bypass were randomized to two different inotropic protocols: milrinone 0.5 mg · kg^–1 · min^–1 or levosimendan 0.1 mg · kg^–1 · min^–1, started immediately after the release of the aortic crossclamp. The treatment was masked to the observers. All patients received dobutamine 5 mg · kg^–1 · min^–1.

RESULTS: Stroke volume was similar between groups initially after surgery, but it declined 12 h after surgery in the milrinone group but not in the levosimendan group (P < 0.05 between groups) despite similar filling pressures. Total dose, duration of inotropic drug administration and norepinephrine dose were lower in the levosimendan group than in the milrinone group (P < 0.05). The duration of tracheal intubation was shorter in the former group compared with the milrinone group (P = 0008). Three patients in the milrinone group but none in the levosimendan group died within 30 days of surgery.

CONCLUSION: In cardiac surgery patients with a low preoperative ejection fraction, stroke volume was better maintained with the combination of dobutamine with levosimendan than with the combination of dobutamine with milrinone.

This article has been cited by other articles:

				P. S. Pagel Levosimendan in Cardiac Surgery: A Unique Drug for the Treatment of Perioperative Left Ventricular Dysfunction or Just Another Inodilator Searching for a Clinical Application? Anesth. Analg., April 1, 2007; 104(4): 759 - 761. [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999