The Early Outcomes of Levosimendan in Patients Undergoing Coronary Artery Bypass Grafting with Impaired Myocardial Function

Abstract

Background: Coronary artery bypass grafting (CABG) is the standard treatment for ischemic heart disease; however, postoperative myocardial dysfunction remains a major concern, particularly in patients with impaired left ventricular (LV) function. Levosimendan, a calcium sensitizer with inotropic and vasodilatory effects, may improve perioperative cardiac performance. This study evaluated the effect of preoperative levosimendan administration on postoperative outcomes in patients undergoing CABG.

Methods: This randomized clinical trial included 60 patients with left ventricular ejection fraction (LVEF) <45% scheduled for isolated CABG. Patients were randomized into two groups: Group A (n=30) received levosimendan infusion at 0.1 μg/kg/min for 24 hours starting 12 hours preoperatively, while Group B (n=30) received conventional inotropic support alone. Postoperative outcomes included hemodynamic parameters, inotropic requirements, duration of mechanical ventilation, and lengths of ICU and hospital stay. LV function was assessed using transthoracic echocardiography according to the American Society of Echocardiography 16-segment model by a blinded echocardiographer within 24–48 hours after ICU admission.

Results: Baseline characteristics were comparable between groups except for a higher preoperative heart rate in the levosimendan group (91.37 ± 10.25 vs. 82.73 ± 6.93 bpm, p=0.001). Postoperatively, the levosimendan group showed significantly lower inotropic requirements on ICU admission (p=0.001), higher diastolic blood pressure (75.6 ± 12.5 vs. 69.0 ± 12.4 mmHg, p=0.042), and improved LVEF (47.0 ± 6.1% vs. 44.0 ± 7.8%, p=0.037). Patients receiving levosimendan also had shorter mechanical ventilation duration (5.9 ± 2.2 vs. 13.8 ± 16.9 hours, p<0.001), ICU stay (2.7 ± 0.7 vs. 4.0 ± 0.8 days, p<0.001), and hospital stay (6.5 ± 1.7 vs. 8.1 ± 2.2 days, p<0.001). Complication and mortality rates did not differ significantly between groups.

Conclusions: Preoperative levosimendan administration in patients with moderately impaired LV function undergoing CABG improves early postoperative cardiac performance, reduces inotropic support requirements, and shortens recovery time without increasing adverse events.