title: Levosimendan Use Increases Cardiac Performance after Coronary Artery Bypass Grafting in End-Stage Renal Disease Patients.
abstract: The effect of levosimendan on myocardial performance has not been studied in dialysis-dependent end-stage renal disease patients who have undergone coronary artery bypass grafting (CABG) surgery. Our aim was to investigate the effect of levosimendan on postoperative hemodynamic effects in end-stage renal disease patients undergoing CABG operation.
  
  
  
  We performed 58 elective isolated CABG operations in end-stage renal disease patients. The study group received levosimendan at a slow bolus dose of 3 µg/kg, followed by a 24-hour infusion of 0.03-0.05 µg/kg/kg/min. (study group [SG]: n = 25). The remaining patients received a placebo (control group [CG]: n = 33). The mean left ventricular ejection fraction of both groups was similar (44.6 ± 55.4% versus 42.8 ± 53.9%). Hemodynamic data were collected at the end, at 1 hour after CPB, and thereafter at 6, 12, and 24 hours in the ICU. Preoperatively, at the end of the operation, at 1 hour after CPB, and thereafter at 6, 12, and 24 hours in the ICU, blood samples from the peripheral vein were collected for cardiac troponin-I (c-TnI) and lactate levels. Norepinephrine if needed started during the rewarming period in both groups.
  
  
  
  One patient in SG (4%) and 4 patients (12.1%) in CG died postoperatively (P &lt; .01). Cardiac output and cardiac index values did not change early after weaning from extracorporeal circulation, and they were nearly similar during the next 6 hours in both groups. In SG, cardiac output and cardiac index significantly improved at 6 hours, and were stable at the end of 24 hours (P &lt; .001). Hemodynamic parameters were nearly similar after the operation, and did not change significantly at the end of 24 hours in CG. Hemodynamic improvement caused a significant reduction in systemic and pulmonary artery vascular resistance index in SG (P &lt; .002). Pulmonary capillary wedge pressure decreased significantly in SG (P &lt; .034). Cumulative inotrope dose requirement and intraaortic balloon pump use were significantly lower in SG. In addition, blood lactate and cTnI levels were significanly lower in SG (P &lt; .044).
  
  
  
  No important adverse effect was detected during levosimendan infusion. Because levosimendan at a dose of 0.03-0.05 μg/kg/min increased myocardial performance significantly in the postoperative period, it can be used safely in end-stage renal disease patients undergoing isolated CABG. The requirement of vasopressors were lower in SG.
authors: Department of Cardiovascular Surgery, Private Mersin Middle-East Hospital, Mersin, Turkey.
authors: Hakan
authors: H
authors: Atalay
authors: Department of Cardiovascular Surgery, The Health Sciences Universtiy, Elazığ Research and Training Center, Elazığ, Turkey.
authors: Zeki
authors: Z
authors: Temizturk
authors: Department of Radiology, The Health and Sciences University, Tunceli Government Hospital, Tunceli, Turkey.
authors: Hasan Baki
authors: HB
authors: Altinsoy
authors: Department of Cardiovascular Surgery, The Health Sciences Universtiy, Elazığ Research and Training Center, Elazığ, Turkey.
authors: Davut
authors: D
authors: Azboy
authors: Instructor of Cardiology, The Health Sciences University, Adana Numune Research and Training Center, Adana, Turkey.
authors: Salih
authors: S
authors: Colak
authors: Department of Cardiovascular Surgery, Çukurova University School of Medicine, Adana, Turkey.
authors: Atakan
authors: A
authors: Atalay
authors: Department of Cardiovascular Surgery, The Health Sciences Universtiy, Numune Research and Training Center Adana, Turkey.
authors: Omer Faruk
authors: OF
authors: Dogan
mesh_terms: D000368:Aged; D002303:Cardiac Output, Low / Q000517:prevention & control*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care; D011724:Pyridazines / Q000008:administration & dosage / Q000627:therapeutic use*; D000077464:Simendan; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D006835:Hydrazones; D011724:Pyridazines; D014665:Vasodilator Agents; D000077464:Simendan