title: The Effects of Levosimendan and Sodium Nitroprusside Combination on Left Ventricular Functions After Surgical Ventricular Reconstruction in Coronary Artery Bypass Grafting Patients.
abstract: OBJECTIVE
  The aim of our study was to research the effects of levosimendan (LS) and sodium nitroprusside (SNP) combination on systolic and diastolic ventricular function after coronary artery bypass grafting (CABG) who required endoventricular patch repair (EVPR).
  
  
  METHODS
  We studied 70 patients with ischemic dilated cardiomyopathy. LS and SNP combination was administered in 35 patients (study group, SG). In the remaining patients, normal saline solution was given (placebo group, PG). Levosimendan (10µgr/kg) started 4 h prior to operation and we stopped LS before the initiation of extracorporeal circulation (ECC). During the rewarming period, we started again levosimendan (10µgr/kg) in combination with SNP (0.1-0.2 µgr/kg/min). If mean blood pressure decreased by more than 25% compared with pre-infusion values, for corrected of mean arterial pressure, the volume loading was performed using a 500 ml ringer lactate. Hemodynamic variables, inotrophyc requirement, and laboratory values were recorded.
  
  
  RESULTS
  Five patients died (7.14%) post-surgery (one from SG and 4 from PG) due to low cardiac out-put syndrome (LOS). At the postoperative period, cardiac output and stroke volume index was higher in SG (mean±sd;29.1±6.3 vs. 18.4±4.9 mL/min(-1)/m(-2) (P<0.0001)). Stroke volume index (SVI) decreased from 29±10mL/m(2) preoperatively to 22±14mL/m(2) in the early postoperative period in group 1. This difference was statistically significant (P=0.002). Cardiac index was higher in SG (320.7±37.5 vs. 283.0±83.9 mL/min(-1)/m-(2) (P=0.009)). The postoperative inotrophyc requirement was less in SG (5.6±2.7 vs. 10.4±2.0 mg/kg, P< 0.008), and postoperative cardiac enzyme levels were less in SG (P< 0.01). Ten patients (28.5%) in SG and 21 patients (60%) in PG required inotrophyc support (P<0.001). We used IABP in eight patients (22.8%) in SG and 17 patients (48.5%) in CG (P=0.0001).
  
  
  CONCLUSIONS
  This study showed that LS and SNP combination impressive increase in left ventricular systolic and diastolic functions including LVEF. The use of this combination achieved more less inotrophics and IABP requirement. We therefore suggest preoperative and peroperative levosimendan and SNP combination.
authors: Elazig Education and Training Hospital, Elazig, Turkey.
authors: Zeki
authors: Z
authors: Temizturk
authors: Elazig Education and Training Hospital, Elazig, Turkey.
authors: Davut
authors: D
authors: Azboy
authors: Cukurova University Medical Faculty, Adana, Turkey.
authors: Atakan
authors: A
authors: Atalay
authors: Private Mersin Middle East Hospital, Mersin, Turkey.
authors: Hakan
authors: H
authors: Atalay
authors: Adana Numune Education and Training Hospital, Adana, Turkey.
authors: Omer Faruk
authors: OF
authors: Dogan
keywords: Left ventricular functions; Levosimendan; Open heart surgery; Sodium nitroprusside