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Levosimendan for patients with impaired left ventricular function undergoing cardiac surgery

Department of Cardiothoracic Surgery, Prince of Wales Hospital, Barker Street, Randwick, New South Wales, 2031, Australia

*Corresponding author. Tel.: +61-2-9382-0490; fax: +61-2-93820493.

E-mail address: tokuda{at}mxb.mesh.ne.jp (Y. Tokuda).

The efficacy of levosimendan treatment for a low cardiac output status following cardiac surgery has not been established. Here, we review our initial experiences of the perioperative use of levosimendan. This study is a retrospective uncontrolled trial. Nine patients who underwent cardiac surgery, and developed a low cardiac output status resistant to conventional inotropic support, were given levosimendan. The mean preoperative ejection fraction was 35.2±3.4%. All patients were on concomitant inotropic agents and had previously undergone intra-aortic balloon pumping. Cardiac index increased immediately from 2.14±0.33 l/min/m² at baseline to 2.41±0.31 (P=0.02) at 1 h, rising to 2.67±0.43 (P<0.001) at 4 h after the loading dose was started. Similarly, the systemic vascular resistance index decreased from 2350±525 dynes/s/cm^–5/m² at baseline to 1774±360 (P=0.002) at 4 h. In the case of all but one of the patients, either the dose of the concomitant inotropic support or the balloon pumping could be weaned down within 24 h after completion of the levosimendan infusion. No withdrawal of levosimendan was required. Levosimendan could constitute a new therapeutic option for postoperative low cardiac output.

Key Words: Levosimendan; Postoperative care; Impaired ventricular function

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