title: Levosimendan versus an intra-aortic balloon pump in high-risk cardiac patients.
abstract: OBJECTIVE
  To test the hypothesis that levosimendan is more effective than intra-aortic balloon pump (IABP) support in cardiac surgical patients with low left ventricular ejection fraction to decrease cardiac troponin I levels (primary endpoint) and improve hemodynamics.
  
  
  METHODS
  Prospective randomized trial.
  
  
  METHODS
  Tertiary cardiothoracic referral center.
  
  
  METHODS
  Ninety patients with coronary artery disease and left ventricular ejection fraction <35% who underwent surgery with cardiopulmonary bypass.
  
  
  METHODS
  Patients were assigned randomly to 1 of 3 groups. Group A received a prophylactic IABP one day before surgery. Group B received a prophylactic IABP one day before surgery and a levosimendan infusion at a dose of 0.1 μg/kg/min with an initial bolus (12 μg/kg for 10 minutes) after anesthesia induction. Group C received a levosimendan infusion at a dose of 0.1 μg/kg/min with an initial bolus (12 μg/kg for 10 minutes) after anesthesia induction. Hemodynamic and biochemical data and rate of complications were analyzed.
  
  
  RESULTS
  The cardiac troponin I level in group C 6 hours after surgery was lower than in group A (p = 0.048). The cardiac index in group A was significantly lower than in groups B and C. The intensive care unit stay was significantly shorter in group C than in groups A and B (p = 0.001). The need for inotropic support, the rate of complications, and mortality among groups did not differ.
  
  
  CONCLUSIONS
  The infusion of levosimendan after anesthesia induction in cardiac surgical patients contributes to lower cardiac troponin I levels and improved hemodynamics compared with a preoperative IABP.
authors: Department of Anesthesiology and Intensive Care, State Research Institute of Circulation Pathology, Novosibirsk, Russia. vvlom@mail.ru
authors: Vladimir V
authors: VV
authors: Lomivorotov
authors: Vladimir A
authors: VA
authors: Boboshko
authors: Sergey M
authors: SM
authors: Efremov
authors: Igor A
authors: IA
authors: Kornilov
authors: Alexandr M
authors: AM
authors: Chernyavskiy
authors: Vladimir N
authors: VN
authors: Lomivorotov
authors: Lubov G
authors: LG
authors: Knazkova
authors: Alexander M
authors: AM
authors: Karaskov
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass; D002316:Cardiotonic Agents / Q000494:pharmacology*; D003324:Coronary Artery Disease / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006835:Hydrazones / Q000494:pharmacology*; D007362:Intensive Care Units; D007423:Intra-Aortic Balloon Pumping; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011724:Pyridazines / Q000494:pharmacology*; D000077464:Simendan; D019210:Troponin I / Q000097:blood
chemical_list: D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D019210:Troponin I; D000077464:Simendan