title: Prophylactic preoperative levosimendan administration in heart failure patients undergoing elective non-cardiac surgery: a preliminary report.
abstract: BACKGROUND
  Preoperative optimization of cardiac failure (CF) patients undergoing non-cardiac surgery is of utmost importance. Levosimendan is a promising adjunct in our therapeutic repertoire for the treatment of CF; however, it has not been evaluated in CF patients undergoing non-cardiac surgery. Our objective was to evaluate the safety and efficacy of prophylactic preoperative levosimendan administration in these patients.
  
  
  METHODS
  CF patients with ejection fraction <35% undergoing elective non-cardiac (abdominal) surgery during a 6-month-period were included in this prospective study. All patients, admitted to the Surgical Intensive Care Unit (SICU) one day preoperatively for levosimendan administration, received a bolus infusion (2.4 Ig/kg) for 10 min followed by a 24-hour continuous infusion (0.1 Ig/kg/min) at the end of which they were operated. Patients were under continuous hemodynamic monitoring in the SICU during levosimendan infusion and for 24 h post-infusion. Hemodynamic parameters, including heart rate, arterial pressure and pulmonary artery catheter data, were recorded before treatment, 10 min after drug initiation, and at 3-hour intervals to 24 h post-infusion. Echocardiography was performed before infusion and on the 7th post-infusion day.
  
  
  RESULTS
  Nine patients were enrolled. Cardiac index (0-48 h, 95% CI: -2.790-0.432, p<0.001) and stroke volume index (0-48 h, 95% CI: -32.53-0.91, p=0.01) increased significantly at 24 h after drug initiation and remained increased for 24 h post-infusion. Systemic vascular resistance index decreased at 10 min and remained reduced during the whole observation period (0-48 h, 95% CI: 875.64-2378.14, p<0.001). Ejection fraction was significantly increased on the 7th post-infusion day (32.65 +/- 7.32 vs. 20.89 +/- 6.24, p<0.05). No adverse reactions, complications or deaths occurred during 30 days' follow up.
  
  
  CONCLUSIONS
  Prophylactic preoperative levosimendan treatment may be safe and efficient for the perioperative optimization of heart failure patients undergoing non-cardiac surgery.
authors.affiliation: Surgical Intensive Care Unit, 1st Department of Propaedeutic Surgery, Hippokrateion Hospital, Athens Medical School, University of Athens, Greece.
authors.forename: Stilianos
authors.initials: S
authors.lastname: Katsaragakis
authors.forename: Athina
authors.initials: A
authors.lastname: Kapralou
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Drimousis
authors.forename: Haridimos
authors.initials: H
authors.lastname: Markogiannakis
authors.forename: Andreas
authors.initials: A
authors.lastname: Larentzakis
authors.forename: George
authors.initials: G
authors.lastname: Kofinas
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Misthos
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Filis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Theodorou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D017558:Elective Surgical Procedures / Q000379:methods*; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006115:Greece / Q000453:epidemiology; D006333:Heart Failure / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods*; D015995:Prevalence; D011446:Prospective Studies; D011724:Pyridazines / Q000008:administration & dosage*; D000077464:Simendan; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan