title: Comparison of levosimendan and nitroglycerine in patients undergoing coronary artery bypass graft surgery.
abstract: BACKGROUND
  Levosimendan a calcium ion sensitizer improves both systolic and diastolic functions. This novel lusitropic drug has predictable antiischemic properties which are mediated via the opening of mitochondrial adenosine triphosphate-sensitive potassium channels. This action of levosimendan is beneficial in cardiac surgical patients as it improves myocardial contractility, decreases systemic vascular resistance (SVR), and increases cardiac index (CI) and is thought to be cardioprotective. We decided to study whether levosimendan has any impact on the outcomes such as the duration of ventilation, the length of Intensive Care Unit (ICU) stay, and the hospital stay when compared with the nitroglycerine (NTG), which is the current standard of care at our center.
  
  
  METHODS
  Forty-seven patients undergoing elective coronary artery bypass surgery were randomly assigned to two groups receiving either levosimendan or NTG. The medications were started before starting surgery and continued until 24 h in the postoperative period. Baseline hemodynamic parameters were evaluated before beginning of the operation and then postoperatively at 3 different time intervals. N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) levels were also measured in both groups.
  
  
  RESULTS
  In comparison to the NTG group, the duration of ventilation and length of ICU stay were significantly less in levosimendan group (P < 0.05, P = 0.02). NT-proBNP level analysis showed a slow rising pattern in both groups and a statistically significant rise in the levels was observed in NTG group (P = 0.03, P = 0.02) in postoperative period when compared to levosimendan group of patients.
  
  
  CONCLUSIONS
  Levosimendan treatment in patients undergoing surgical revascularization resulted in improved CI, decreased SVR and lower heart rate. And, thereby the duration of ventilation and length of ICU stay were significantly less in this group of patients when compared with NTG group.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Manoj K
authors.initials: MK
authors.lastname: Sahu
authors.forename: Anupam
authors.initials: A
authors.lastname: Das
authors.forename: Vishwas
authors.initials: V
authors.lastname: Malik
authors.forename: Arun
authors.initials: A
authors.lastname: Subramanian
authors.forename: Sarvesh Pal
authors.initials: SP
authors.lastname: Singh
authors.forename: Milind
authors.initials: M
authors.lastname: Hote
mesh_terms: D000368:Aged; D002302:Cardiac Output / Q000187:drug effects; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D001026:Coronary Artery Bypass / Q000379:methods*; D003422:Critical Care; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D005996:Nitroglycerin / Q000627:therapeutic use*; D010446:Peptide Fragments / Q000097:blood; D011724:Pyridazines / Q000627:therapeutic use*; D012121:Respiration, Artificial; D000077464:Simendan; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D002316:Cardiotonic Agents; D006835:Hydrazones; D010446:Peptide Fragments; D011724:Pyridazines; D014665:Vasodilator Agents; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D000077464:Simendan; D005996:Nitroglycerin