title: Timing of levosimendan in cardiac surgery.
abstract: OBJECTIVE
  Levosimendan (LS) is a new inodilator agent that improves cardiac contractility by increasing the sensitivity of troponin C to calcium, which usage in cardiac surgery has been growing in the recent years. We aimed to determine the best timing of the administration of LS in high-risk patients who underwent cardiovascular surgery.
  
  
  METHODS
  Fifteen patients were evaluated retrospectively who have left ventricular dysfunction, underwent open-heart surgery and were applied LS in different phases of operation. Patients were divided into 3 groups according to timing of LS. Levosimendan infusion (0. 1 microg-1kg-1min) was applied after the induction of anaesthesia (n=5) (Group 1), during the pump removal period (n=5) (Group 2) and in postoperative period (n=5) (Group 3). Demographic data, operative characteristics, mean arterial pressure (MAP), mean pulmonary arterial pressure (MPAP), pulmonary wedge capillary pressure (PWCP), cardiac index (CI), inotropic agent consumption, postoperative urine output, lactate levels of groups were compared between before and after LS treatment. Data were evaluated by Fisher exact, Kruskal-Wallis, Mann-Whitney U and Wilcoxon rank tests.
  
  
  RESULTS
  In all patients, urine output was satisfactory 24 hours after LS application. There was a significant increase in CI of all 3 groups (p=0.04). Also, there was a significant decrease in PCWP of all 3 groups before and after LS (p=0.04). There was a significant decrease in MPAP in Group 2 and 3 (p=0.04). Twenty- four hours after LS application, whereas all inotropic agents could be stopped in Group 1 and 2, in Group 3 inotropic infusion (dopamine [10 microg-1kg-1min (5-17.5)], dobutamine [15 microg-1kg-1min (5-20)] and adrenaline [0.4 microg-1kg-1min (0.15-0.65)]) couldn't be stopped (p=0.007). During postoperative period, in Groups 1 and 2 one case from each required intraaortic balloon pump, while in Group 3 four patients were applied intraaortic balloon pump (p=0.08).
  
  
  CONCLUSIONS
  According to our experience, LS is effective in high-risk cases during cardiac surgery, especially during the intra-operative and pump removal periods;however, no successful outcomes were observed during the post-operative period. As a result, case selection and timing should be performed well when using LS.
authors.affiliation: From II. Clinic of Anesthesiology and Reanimation, Izmir Atatürk Training and Research Hospital, Izmir, Turkey. murataksun@yahoo.com
authors.forename: Murat
authors.initials: M
authors.lastname: Aksun
authors.forename: Nagihan
authors.initials: N
authors.lastname: Karahan
authors.forename: Tayfun
authors.initials: T
authors.lastname: Adanir
authors.forename: Gülçin
authors.initials: G
authors.lastname: Aran
authors.forename: Ufuk
authors.initials: U
authors.lastname: Yetkin
authors.forename: Tülin
authors.initials: T
authors.lastname: Oztürk
authors.forename: Atilla
authors.initials: A
authors.lastname: Sencan
authors.forename: Uğur
authors.initials: U
authors.lastname: Ozgürbüz
authors.forename: Ali
authors.initials: A
authors.lastname: Gürbüz
mesh_terms: D000368:Aged; D002303:Cardiac Output, Low / Q000188:drug therapy*; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage*; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects; D018579:Patient Selection; D011182:Postoperative Care; D011724:Pyridazines / Q000008:administration & dosage*; D012189:Retrospective Studies; D000077464:Simendan; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000601:surgery*
chemical_list: D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan