The Preoperative Use of Levosimendan in Patients undergoing Coronary Artery Bypass Surgery with Low Ejection Fraction

Basem Abdelgawad; Yousry  Shahin; Anhar  Abd-Ellatif; Mohamed  Abdelrahman; Mohamed  Ali; Ahmed  El sayad; Mohamed  Elgazzar

doi:10.35810/ects.v3i4.194

Basem Abdelgawad Department of Cardiothoracic Surgery, Faculty of Medicine, Benha University, Benha, Egypt
Yousry Shahin Department of Cardiothoracic Surgery, Faculty of Medicine, Benha University, Benha, Egypt
Anhar Abd-Ellatif Department of Cardiothoracic Surgery, Faculty of Medicine, Benha University, Benha, Egypt
Mohamed Abdelrahman Department of Anesthesia and Intensive Care, Faculty of Medicine, Benha University, Benha, Egypt
Mohamed Ali Department of Cardiology, Faculty of Medicine, Benha University, Benha, Egypt
Ahmed El sayad Department of Critical Care, Shebin Elkom Teaching Hospital, Shebin Elkom, Egypt
Mohamed Elgazzar Department of Cardiothoracic Surgery, Faculty of Medicine, Benha University, Benha, Egypt

DOI: https://doi.org/10.35810/ects.v3i4.194

Keywords: Levosimendan, Low cardiac output, Myocardial ischemia

Abstract

Background: Levosimendan is a calcium sensitizer with positive inotropic, vasodilatory, and cardioprotective actions. Levosimendan infusion time may affect the outcomes. Our objective was to evaluate its efficacy and safety when used before coronary artery bypass grafting (CABG) in patients with low ejection fraction.

Methods: This prospective observational study included 150 CABG patients with ejection fraction ≤ 40% divided into two groups. In the Levosimendan group (n= 75), it was given preoperatively, and in the conventional group (n= 75), myocardial support was used if indicated.

Results: Operative time (344±28.7 vs. 421.4±34.5 min) and cardiopulmonary bypass time (97±17.4 vs. 127.4±24.5) were significantly shorter in the Levosimendan group (P˂ 0.001, for both). Failure to wean from bypass (13 (17.3%) vs. 23 (30.7%), P=0.06) and the need for intra-aortic balloon pump (6 (8%) vs. 14 (18.7%), P= 0.06) were non significantly lower in the Levosimendan group. The mechanical ventilation duration (12±3.3 vs. 19.6±4.7 h, P= 0.04) and ICU stay (3.8±1.2 vs. 5.3±1.4 days, P ˂ 0.001) were lower with levosimendan. Mortality was non-significantly lower in the Levosimendan group (10 (13.3%) vs. 18 (24%), P= 0.09). There were no differences in atrial and ventricular arrhythmias between groups.

Conclusion: The preoperative use of levosimendan could improve the outcomes in patients undergoing CABG with low ejection fraction. Levosimendan complication profile was comparable to the conventional approach