title: Study of levosimendan during off-pump coronary artery bypass grafting in patients with LV dysfunction: a double-blind randomized study.
abstract: OBJECTIVE
  Levosimendan is a calcium sensitizer drug which has been used in cardiac surgery for the prevention of postoperative low cardiac output syndrome (LCOS) and in difficult weaning from cardiopulmonary bypass (CPB). This study aims to evaluate perioperative hemodynamic effects of levosimendan pretreatment in patients for off-pump coronary artery bypass graft (OPCABG) surgery with low left ventricular ejection fractions (LVEF < 30%).
  
  
  METHODS
  Fifty patients undergoing OPCABG surgery with low LVEF (<30%) were enrolled in the study. Patients were randomly divided in two groups: Levosimendan pretreatment (Group L) and placebo pretreatment (Group C) of 25 each. Group L, patients received levosimendan infusion 200 μg/kg over 24 h and in Group C Patients received placebo. The clinical parameters measured before and after the drug administration up to 48 h were heart rate (HR; for the hour after drug infusion), cardiac index (CI), and pulmonary capillary wedge pressure (PCWP). The requirement of inotropes, intraaortic balloon pump (IABP), CPB, intensive care unit (ICU) stay, and hospital stay were also measured.
  
  
  RESULTS
  The patients in group L exhibited higher CI and PCWP during operative in early postoperative period as compared to control group C. Group L also had a less requirement for inotropes, CPB support and IABP with shorter ICU stay as well as hospital stay.
  
  
  CONCLUSIONS
  Levosimendan pretreatment (24 h infusion) in patient for OPCABG with poor LVEF shows better outcomes and hemodynamics in terms of inotropes, CPB and IABP requirements. It also reduces ICU stay.
authors.affiliation: Chief Cardiac Anesthesiologist, SAL Hospital, Ahmadabad, Gujarat, India.
authors.forename: B
authors.initials: B
authors.lastname: Shah
authors.affiliation: Chief Cardiac Anesthesiologist, SAL Hospital, Ahmadabad, Gujarat, India.
authors.forename: P
authors.initials: P
authors.lastname: Sharma
authors.affiliation: Chief Cardiac Anesthesiologist, SAL Hospital, Ahmadabad, Gujarat, India.
authors.forename: A
authors.initials: A
authors.lastname: Brahmbhatt
authors.affiliation: Chief Cardiac Anesthesiologist, SAL Hospital, Ahmadabad, Gujarat, India.
authors.forename: R
authors.initials: R
authors.lastname: Shah
authors.affiliation: Chief Cardiac Anesthesiologist, SAL Hospital, Ahmadabad, Gujarat, India.
authors.forename: B
authors.initials: B
authors.lastname: Rathod
authors.affiliation: Chief Cardiac Anesthesiologist, SAL Hospital, Ahmadabad, Gujarat, India.
authors.forename: Naman
authors.initials: N
authors.lastname: Shastri
authors.affiliation: Chief Cardiac Anesthesiologist, SAL Hospital, Ahmadabad, Gujarat, India.
authors.forename: J
authors.initials: J
authors.lastname: Patel
authors.affiliation: Chief Cardiac Anesthesiologist, SAL Hospital, Ahmadabad, Gujarat, India.
authors.forename: A
authors.initials: A
authors.lastname: Malhotra
mesh_terms: D000368:Aged; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000601:surgery*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011724:Pyridazines / Q000627:therapeutic use*; D000077464:Simendan; D016277:Ventricular Function, Left
chemical_list: D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan
keywords: CPB; Cardiac index; LCOS; OPCABG surgery; hemodynamic optimization; inotropic agents; levosimendan; off-pump coronary artery bypass graft; pulmonary capillary wedge pressure