title: Levosimendan vs. intra-aortic balloon pump in high-risk cardiac surgery.
abstract: The purpose of our study was to compare the efficiency of levosimendan and preventive intra-aortic balloon pump in high-risk cardiac patients (left ventricular ejection fraction <35%) operated under cardiopulmonary bypass. In 20 patients, intra-aortic balloon pump was started 16-18 h before surgery; another 20 had a levosimendan infusion starting after induction of anesthesia with an initial bolus of 12 μg·kg(-1) for 10 min, followed by 0.1 μg·kg(-1)·min(-1) for 24 h. Postoperative complications, hemodynamics, and markers of cardiac damage were analyzed. In the levosimendan group, cardiac index was significantly higher 5 min after cardiopulmonary bypass, at the end of the operation, 2 and 4 h after perfusion, compared to the intra-aortic balloon pump group. The level of troponin I in the levosimendan group was significantly lower at 6 h after the operation. Intensive care unit stay was significantly shorter in the levosimendan group. It was concluded that the use of levosimendan in high-risk cardiac patients is as effective as intra-aortic balloon pump, in terms of maintaining stable hemodynamic during and after operations under cardiopulmonary bypass. The lower level of troponin I at 6 h postoperatively suggests cardioprotective properties of levosimendan, but requires further investigation.
authors.affiliation: Academician E N Meshalkin Research Institute of Circulation Pathology, Novosibirsk, Russia. vvlom@mail.ru
authors.forename: Vladimir V
authors.initials: VV
authors.lastname: Lomivorotov
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Cherniavskiy
authors.forename: Vladimir A
authors.initials: VA
authors.lastname: Boboshko
authors.forename: Igor A
authors.initials: IA
authors.lastname: Kornilov
authors.forename: Vladimir N
authors.initials: VN
authors.lastname: Lomivorotov
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Karaskov
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D006439:Hemodynamics; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage*; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D011724:Pyridazines / Q000008:administration & dosage*; D018570:Risk Assessment; D012307:Risk Factors; D012426:Russia; D000077464:Simendan; D013318:Stroke Volume; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D019210:Troponin I; D000077464:Simendan