Levosimendan for weaning from cardiopulmonary bypass after coronary artery bypass grafting.
BACKGROUND
Although cathecholamines are well-established agents of myocardial support during weaning from cardiopulmonary bypass (CPB), there has been little experience with a new inotropic agent, levosimendan. Our aim was to present our experience with levosimendan usage in patients manifesting failure-to-wean from CPB after coronary artery bypass grafting (CABG) when conventional inotropic and intraaortic balloon counterpulsation (IABP) therapies proved to be insufficient.


METHODS
Fifteen patients undergoing CABG received levosimendan as a loading dose of 12-24 microg/kg over 10 min, followed by a continuous infusion of 0.1-0.2 microg/(kg min) for 24h. Hemodynamic measurements were performed at baseline and at 1, 24 and 48 h postoperatively.


RESULTS
Mean patient age was 63.2+/-2.2 years. CPB time was 149.7+/-19.5 min, while cross-clamp time was 67.8+/-10.5 min. All patients showed evidence of hemodynamic improvement with the start of levosimendan infusion and 14 patients (93.3%) were successfully weaned from CPB. Eight patients (53.3%) experienced significant increases in cardiac index and blood pressure leading to a lessening of the need for catecholamine support. Five patients (33.3%) were lost postoperatively in the ICU.


CONCLUSIONS
Levosimendan appears to be useful in failure-to-wean from CPB after cardiotomy when conventional inotropic therapy proves inadequate.
Akgul
Ahmet
A
Department of Cardiovascular Surgery, Yuksek Ihtisas Hospital, Ankara, Turkey. aakgul@hotmail.com <aakgul@hotmail.com>
Mavioglu
Levent
L
Katircioglu
S Fehmi
SF
Pac
Mustafa
M
Cobanoglu
Adnan
A
D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D002315:Cardiopulmonary Bypass; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D011724:Pyridazines / Q000008:administration & dosage*; D000077464:Simendan; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000379:methods*
D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan