title: The Role of Levosimendan in Patients with Decreased Left Ventricular Function Undergoing Cardiac Surgery.
abstract: The postoperative low cardiac output is one of the most important complications following cardiac surgery and is associated with increased morbidity and mortality. The condition requires inotropic support to achieve adequate hemodynamic status and tissue perfusion. While catecholamines are utilised as a standard therapy in cardiac surgery, their use is limited due to increased oxygen consumption. Levosimendan is calcium sensitising inodilatator expressing positive inotropic effect by binding with cardiac troponin C without increasing oxygen demand. Furthermore, the drug opens potassium ATP (KATP) channels in cardiac mitochondria and in the vascular muscle cells, showing cardioprotective and vasodilator properties, respectively. In the past decade, levosimendan demonstrated promising results in treating patients with reduced left ventricular function when administered in peri- or post- operative settings. In addition, pre-operative use of levosimendan in patients with severely reduced left ventricular ejection fraction may reduce the requirements for postoperative inotropic support, mechanical support, duration of intensive care unit stay as well as hospital stay and a decrease in post-operative mortality. However, larger studies are needed to clarify clinical advantages of levosimendan versus conventional inotropes.
authors.affiliation: Clinical Department of Anesthesiology and Perioperative Intensive Therapy, Division of Cardiac Anesthesiology and Intensive Therapy, University Clinical Center Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia.
authors.forename: Marija
authors.initials: M
authors.lastname: Bozhinovska
authors.affiliation: Clinical Department of Anesthesiology and Perioperative Intensive Therapy, Division of Cardiac Anesthesiology and Intensive Therapy, University Clinical Center Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia.
authors.forename: Gordana
authors.initials: G
authors.lastname: Taleska
authors.affiliation: Institute of Physiology, Medical Faculty, University of Ljubljana, Slovenia; Department of Vascular Neurology and Neurological Intensive Therapy, University Clinical Centre Ljubljana, Slovenia.
authors.forename: Andrej
authors.initials: A
authors.lastname: Fabian
authors.affiliation: Clinical Department of Anesthesiology and Perioperative Intensive Therapy, Division of Cardiac Anesthesiology and Intensive Therapy, University Clinical Center Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia.
authors.forename: Maja
authors.initials: M
authors.lastname: Šoštarič
keywords: Cardiac surgery; Heart failure; Levosimendan; Myocardial dysfunction; Ventricular function