Preconditioning effects of levosimendan in coronary artery bypass grafting--a pilot study.
BACKGROUND
The calcium sensitizer levosimendan protects against myocardial ischaemia and reperfusion injury in animal models.


METHODS
The present pilot study investigated whether a short infusion before coronary artery bypass grafting (CABG) would protect the myocardium and improve postoperative haemodynamics. Twenty-four patients with stable angina undergoing elective CABG surgery were randomized to receive either placebo or levosimendan (24 microg kg(-1)) infused i.v. over a 10 min period just before placing the patient on cardiopulmonary bypass.


RESULTS
Perioperative haemodynamic variables, concentrations of cardiac troponin I over the 48 h postoperative period, and clinical outcomes were assessed. There were no adverse effects related to levosimendan. Compared with control patients, levosimendan-treated patients had lower postoperative troponin I concentrations (P<0.05) and a higher cardiac index (P<0.05).


CONCLUSIONS
Patients receiving a short infusion of levosimendan before CABG showed evidence of less myocardial damage, suggestive of a preconditioning effect. Larger outcome studies are thus indicated to confirm benefit.
Tritapepe
L
L
Department of Anesthesiology and Intensive Care, University of Rome La Sapienza, Rome, Italy.
De Santis
V
V
Vitale
D
D
Santulli
M
M
Morelli
A
A
Nofroni
I
I
Puddu
P E
PE
Singer
M
M
Pietropaoli
P
P
D000368:Aged; D000787:Angina Pectoris / Q000601:surgery; D015415:Biomarkers / Q000097:blood; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D001026:Coronary Artery Bypass; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control; D010865:Pilot Projects; D011300:Preoperative Care / Q000379:methods; D011724:Pyridazines / Q000627:therapeutic use*; D000077464:Simendan; D019210:Troponin I / Q000097:blood
D015415:Biomarkers; D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D019210:Troponin I; D000077464:Simendan