title: Peri-operative Levosimendan in Patients Undergoing Cardiac Surgery: An Overview of the Evidence.
abstract: Levosimendan, a calcium sensitiser, has recently emerged as a valuable agent in the peri-operative management of cardiac surgery patients. Levosimendan is a calcium-sensitising ionodilator. By binding to cardiac troponin C and reducing its calcium-binding co-efficient, it enhances myofilament responsiveness to calcium and thus enhances myocardial contractility without increasing oxygen demand. Current evidence suggests that levosimendan enhances cardiac function after cardiopulmonary bypass in patients with both normal and reduced left ventricular function. In addition to being used as post-operative rescue therapy for low cardiac output syndrome, a pre-operative levosimendan infusion in high risk patients with poor cardiac function may reduce inotropic requirements, the need for mechanical support, the duration of intensive care admissions as well as post-operative mortality. Indeed, it is these higher-risk patients who may experience a greater degree of benefit. Larger, multicentre randomised trials in cardiac surgery will help to elucidate the full potential of this agent.
authors: Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, NSW, Australia; Department of Cardiovascular Medicine, John Hunter Hospital, Newcastle, NSW, Australia; The University of Melbourne, Australia. Electronic address: william.y.shi@gmail.com.
authors: William Y
authors: WY
authors: Shi
authors: Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, NSW, Australia.
authors: Sheila
authors: S
authors: Li
authors: Department of Cardiovascular Medicine, John Hunter Hospital, Newcastle, NSW, Australia.
authors: Nicholas
authors: N
authors: Collins
authors: Department of Anaesthesia, John Hunter Hospital, Newcastle, NSW, Australia.
authors: David B
authors: DB
authors: Cottee
authors: Department of Cardiovascular Medicine, John Hunter Hospital, Newcastle, NSW, Australia.
authors: Bruce C
authors: BC
authors: Bastian
authors: Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, NSW, Australia.
authors: Allen N
authors: AN
authors: James
authors: Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, NSW, Australia.
authors: Ross
authors: R
authors: Mejia
mesh_terms: D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D005260:Female; D006801:Humans; D006835:Hydrazones / Q000493:pharmacokinetics / Q000627:therapeutic use*; D008297:Male; D009206:Myocardium / Q000378:metabolism; D019990:Perioperative Care / Q000379:methods*; D011724:Pyridazines / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000077464:Simendan; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan
keywords: Cardiac surgery; Heart failure; Levosimendan; Myocardial function; Ventricular function