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Eur J Cardiothorac Surg 2007;32:629-633. doi:10.1016/j.ejcts.2007.07.010
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Efficacy and safety of perioperative infusion of levosimendan in patients with compromised cardiac function undergoing open-heart surgery: importance of early use

^a ICU, Onassis Cardiac Surgery Center, Athens, Greece
^b Department of Anaesthesiology, Onassis Cardiac Surgery Center, Athens, Greece
^c 1st Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
^d Department of Immunopathology & Histocompatibility, Onassis Cardiac Surgery Center, Athens, Greece

Received 10 April 2007; received in revised form 6 July 2007; accepted 9 July 2007.

^_* Corresponding author. Address: Marathonomahon 18, 14572 Athens, Greece. Tel.: +30 210 8133257. (Email: atacard{at}hotmail.com).

Objective: Levosimendan is a promising new inotrope. We investigate the proper time for its infusion during or after open-heart surgery to avoid complications related with low-output syndrome and high dosage of inotropes. Methods: Forty-five consecutive patients were randomised to receive levosimendan in addition to the conventional therapy, its infusion starting in the operating theatre (Group OT) or in the ICU (Group ICU) when low-output syndrome was certified and were consequently dependent on classical inotropic support and IABP. Levosimendan was infused at a rate of 0.1 µg/kg min without loading dose, the infusion being for at least 24 h to a maximum 48 h. Results: Levosimendan was well tolerated, with the simultaneous infusion of norepinephrine if required. Its efficacy was identical in both groups with improvement in the haemodynamic and functional status of patients (amelioration of stroke volume, cardiac index and mixed venous blood oxygen saturation, increase of left ventricular ejection fraction by echo study, de-escalation of traditional inotropes, subtraction of IABP and reduction in BNP plasma levels). The ICU stay and hospital stay were significantly decreased in patients of Group OT, compared to patients of Group ICU. Four patients died because of multiple organs dysfunction syndrome (MODS) due to sepsis (all patients of Group ICU). Conclusion: Levosimendan is a safe and efficient choice in the management of low-output syndrome during and after open-heart surgery. The shortening of hospitalisation and the trend for better outcome confirm its clear superiority when the infusion starts from the operating theatre.

Key Words: Levosimendan • Perioperative infusion • Open-heart surgery • Low-output syndrome

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