Preoperative levosimendan infusion in combined aortic valve and coronary bypass surgery.
BACKGROUND
Cardiopulmonary bypass may have detrimental effects on intestinal function and decrease the concentrations of the active, long-acting metabolites of levosimendan, an inodilator used to improve cardiac function. The aim of this study was to evaluate the haemodynamic effects of preoperative levosimendan in patients undergoing high-risk cardiac surgery.


METHODS
Twenty-four patients were randomized to receive levosimendan (12 µg bolus followed by an infusion of 0.2 µg kg(-1) min(-1)) or a placebo 24 h before surgery. The inclusion criteria were left ventricular ejection fraction (LVEF) <50% or LV hypertrophy indicated by a wall thickness of >12 mm. Haemodynamics were recorded every hour for 24 h (pulmonary artery catheter) and daily until postoperative day 4 (whole-body impedance cardiography). Doppler echocardiography with tissue Doppler imaging was used to assess systolic and diastolic cardiac function.


RESULTS
The cardiac index (CI) and stroke volume index (SI) were higher in the levosimendan group (LG) for the 4 day postoperative period (P<0.05); on the fourth postoperative day, the CI was 3.0 litre m(-2) min(-1) in the LG compared with 2.4 litre m(-2) min(-1) in the control group (CG) and the SI was 30 vs 25 ml m(-2), respectively. The LVEF measured at baseline and on the fourth postoperative morning decreased in the CG, but was maintained in the LG.


CONCLUSIONS
Levosimendan improved haemodynamics compared with a placebo in patients undergoing high-risk cardiac surgery. The concentrations of levosimendan's metabolites were higher compared with earlier studies using perioperative dosing.
Department of Anaesthesia, Tampere University Hospital, PO Box 2000, Tampere 33521, Finland. heli.leppikangas@pshp.fi
H
H
Leppikangas
K
K
Järvelä
T
T
Sisto
P
P
Maaranen
M
M
Virtanen
P
P
Lehto
S
S
Karlsson
T
T
Kööbi
L
L
Lindgren
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D002302:Cardiac Output / Q000187:drug effects; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology*; D001026:Coronary Artery Bypass; D015150:Echocardiography, Doppler; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D011724:Pyridazines / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology*; D000077464:Simendan; D013318:Stroke Volume / Q000187:drug effects
D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan