Levosimendan for weaning from cardiopulmonary bypass after coronary artery bypass grafting

Abstract

Background: Although cathecholamines are well-established agents of myocardial support during weaning from cardiopulmonary bypass (CPB), there has been little experience with a new inotropic agent, levosimendan. Our aim was to present our experience with levosimendan usage in patients manifesting failure-to-wean from CPB after coronary artery bypass grafting (CABG) when conventional inotropic and intraaortic balloon counterpulsation (IABP) therapies proved to be insufficient.

Methods: Fifteen patients undergoing CABG received levosimendan as a loading dose of 12-24 microg/kg over 10 min, followed by a continuous infusion of 0.1-0.2 microg/(kg min) for 24h. Hemodynamic measurements were performed at baseline and at 1, 24 and 48 h postoperatively.

Results: Mean patient age was 63.2+/-2.2 years. CPB time was 149.7+/-19.5 min, while cross-clamp time was 67.8+/-10.5 min. All patients showed evidence of hemodynamic improvement with the start of levosimendan infusion and 14 patients (93.3%) were successfully weaned from CPB. Eight patients (53.3%) experienced significant increases in cardiac index and blood pressure leading to a lessening of the need for catecholamine support. Five patients (33.3%) were lost postoperatively in the ICU.

Conclusion: Levosimendan appears to be useful in failure-to-wean from CPB after cardiotomy when conventional inotropic therapy proves inadequate.