Levosimendan in cardiac surgery.
OBJECTIVE
Levosimendan is a new calcium sensitizer with inodilatory properties. There is growing clinical experience with levosimendan given to cardiac surgical patients. The aim of this report was to evaluate the effects of perioperative use of levosimendan in surgical patients with high perioperative risk, compromised left ventricular (LV) function, or difficulties in weaning from cardiopulmonary bypass (CPB).


METHODS
Case series.


METHODS
Single-institution, university hospital.


METHODS
Patients undergoing cardiac surgery.


RESULTS
Sixteen cardiac surgical patients received levosimendan infusion with a maximum duration of 29 hours. Eight were initiated preoperatively and 8 postoperatively. Coronary artery disease was the main operative indication in 10 of 16 cases, and 75% of the patients were high-risk patients.


RESULTS
Continuous levosimendan infusion increased cardiac index significantly in both groups compared with preoperative baseline. Pulmonary capillary wedge pressure and systolic blood pressure did not change significantly. Norepinephrine and epinephrine were the most common concomitant vasoactive medications. Most importantly, weaning from CPB was successful in all patients even after failure to wean the patient with catecholamines. One high-risk patient in the preoperative group and 2 patients in the postoperative group died in the hospital. Another patient died during the 1-year follow-up.


CONCLUSIONS
Levosimendan can be used for postoperative rescue therapy for patients difficult to wean from CPB. Also, elective preoperative initiation of levosimendan seems applicable to patients with high perioperative risk or compromised LV function.
Siirilä-Waris
Krista
K
Department of Medicine, Helsinki University Hospital, Finland.
Suojaranta-Ylinen
Raili
R
Harjola
Veli-Pekka
VP
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass / Q000379:methods; D003324:Coronary Artery Disease / Q000601:surgery; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D008297:Male; D020105:Milrinone / Q000008:administration & dosage; D009638:Norepinephrine / Q000008:administration & dosage; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011724:Pyridazines / Q000627:therapeutic use*; D012307:Risk Factors; D000077464:Simendan; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D014665:Vasodilator Agents / Q000008:administration & dosage; D014667:Vasopressins / Q000008:administration & dosage; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000601:surgery
D000889:Anti-Arrhythmia Agents; D006835:Hydrazones; D011724:Pyridazines; D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; D014667:Vasopressins; D000077464:Simendan; D020105:Milrinone; D009638:Norepinephrine; D004837:Epinephrine