Levosimendan in patients with cardiogenic shock undergoing surgical revascularization: a case series.
BACKGROUND
Levosimendan is a new calcium sensitizer, which enhances myocardial contractility while simultaneously having vasodilatory and cardioprotective effects. These properties could be advantageous in patients with myocardial ischemia requiring inotropic support.


METHODS
10 patients with acute myocardial ischemia, cardiogenic shock, and/or cardiopulmonary resuscitation undergoing emergency surgical revascularization were treated with levosimendan (bolus 6 microg.kg(-1), continuous infusion 0.2 microg.kg(-1).min(-1)) in addition to catecholamines.


RESULTS
All patients treated with levosimendan and catecholamines were weaned successfully from CPB on the 1st attempt. All patients needed additional norepinephrine because of vasodilation. In 4 patients, levosimendan was stopped in the early postoperative period. 2 patients died, 8 patients survived without any multiorgan failure. Only 2 patients needed an additional intra-aortic balloon pump. In the surviving patients, postoperative ventilation lasted for 8-72 hours.


CONCLUSIONS
Levosimendan may have exerted positive inotropic and cardioprotective effects in these high risk patients with acute myocardial ischemia. However, these preliminary results supporting the use of levosimendan as an inoprotective drug need to be confirmed by a large randomized prospective trial.
Lehmann
Andreas
A
Department of Anesthesiology and Intensive Care Medicine, Municipal Hospital, Ludwigshafen, Germany. lehmanna@klilu.de
Lang
Johannes
J
Boldt
Joachim
J
Isgro
Frank
F
Kiessling
Arndt Holger
AH
D000328:Adult; D000368:Aged; D002316:Cardiotonic Agents / Q000494:pharmacology; D004298:Dopamine / Q000494:pharmacology*; D005260:Female; D006801:Humans; D006835:Hydrazones / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000494:pharmacology*; D011724:Pyridazines / Q000494:pharmacology*; D012770:Shock, Cardiogenic / Q000188:drug therapy* / Q000601:surgery; D000077464:Simendan; D014656:Vascular Surgical Procedures; D014662:Vasoconstrictor Agents / Q000494:pharmacology
D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D014662:Vasoconstrictor Agents; D000077464:Simendan; D004298:Dopamine; D009638:Norepinephrine