title: Comparison of Levosimendan versus Dobutamine in Patients with Moderate to Severe Left Ventricular Dysfunction Undergoing Off-pump Coronary Artery Bypass Grafting: A Randomized Prospective Study.
abstract: BACKGROUND
  Recent upsurge in referral of patients with compromised left ventricular (LV) function for cardiac surgery has led to an increasing use inotropes to achieve improvement of tissue perfusion in the perioperative period.
  
  
  OBJECTIVE
  To compare the hemodynamic effects and immediate postoperative outcomes with levosimendan and dobutamine in patients with moderate to severe LV dysfunction undergoing off-pump coronary artery bypass grafting (OPCAB).
  
  
  METHODS
  University teaching hospital, randomized control study.
  
  
  METHODS
  Eighty patients were randomly divided into two groups of 40 each. Group I received levosimendan at 0.1 μg/kg/min and Group II received dobutamine at 5 μg/kg/min. Hemodynamic data were noted at 30 min, during obtuse marginal grafting, 1, 6, 12, and 24 h after surgery. Heart rate (HR), mean arterial pressure (MAP), pulmonary capillary wedge pressure (PCWP), cardiac index (CI), systemic vascular resistance index (SVRI) and pulmonary vascular resistance index (PVRI), left ventricular stroke work index (LVSWI) and right ventricular stroke work index (RVSWI), mixed venous oximetry (SvO2), and lactate were measured.
  
  
  METHODS
  Chi-square and Student's t-test.
  
  
  RESULTS
  The HR, MAP, PCWP, SVRI, and PVRI were lower in Group I when compared to Group II. Group I patients showed a statistically significant increase in LVSWI, RVSWI, and CI, when compared to Group II. Comparatively, Group I patients maintained higher SvO2and lower lactate levels. Duration of ventilation, Intensive Care Unit (ICU), and hospital stay were lower in Group I.
  
  
  CONCLUSIONS
  Levosimendan was associated with statistically significant increase in indices of contractility (CI, LVSWI, and RVSWI) and decrease in PCWP during and after OPCAB. Levosimendan group had lower incidence of atrial fibrillation, shorter length of ICU, and hospital stay.
authors.affiliation: Department of Cardiothoracic Anesthesia, SRM Medical College Hospital and Research Centre, SRM University, Kattankulathur, Chennai, Tamil Nadu, India.
authors.forename: Ashok
authors.initials: A
authors.lastname: Kandasamy
authors.affiliation: Department of Cardiothoracic Anesthesia, SRM Medical College Hospital and Research Centre, SRM University, Kattankulathur, Chennai, Tamil Nadu, India.
authors.forename: Hariharan Antony
authors.initials: HA
authors.lastname: Simon
authors.affiliation: Department of Cardiothoracic Anesthesia, SRM Medical College Hospital and Research Centre, SRM University, Kattankulathur, Chennai, Tamil Nadu, India.
authors.forename: P
authors.initials: P
authors.lastname: Murthy
authors.affiliation: Department of Cardiothoracic Anesthesia, SRM Medical College Hospital and Research Centre, SRM University, Kattankulathur, Chennai, Tamil Nadu, India.
authors.forename: Mahalakshmi
authors.initials: M
authors.lastname: Annadurai
authors.affiliation: Department of Cardiothoracic Anesthesia, SRM Medical College Hospital and Research Centre, SRM University, Kattankulathur, Chennai, Tamil Nadu, India.
authors.forename: Mushkath Mohamed
authors.initials: MM
authors.lastname: Ali
authors.affiliation: Department of Cardiothoracic Anesthesia, SRM Medical College Hospital and Research Centre, SRM University, Kattankulathur, Chennai, Tamil Nadu, India.
authors.forename: Gayathri
authors.initials: G
authors.lastname: Ramanathan
mesh_terms: D000328:Adult; D000368:Aged; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D047549:Coronary Artery Bypass, Off-Pump; D004280:Dobutamine / Q000627:therapeutic use*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D011724:Pyridazines / Q000627:therapeutic use*; D012720:Severity of Illness Index; D000077464:Simendan; D018487:Ventricular Dysfunction, Left / Q000601:surgery*
chemical_list: D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan; D004280:Dobutamine