Preoperative levosimendan in ischemic mitral valve repair

Abstract

Background: Levosimendan is a new calcium sensitizing drug with vasodilatory and inotropic properties, which is used for the treatment of postoperative low cardiac output syndrome and difficult weaning from cardiopulmonary bypass.

Objective: To evaluate the hemodynamic effects of levosimendan during and after coronary artery bypass grafting on cardiopulmonary bypass and mitral valve repair in patients with low left ventricular ejection fractions (<30%).

Methods: 40 patients were enrolled in this double-blind prospective randomized controlled trial. They received either levosimendan or a placebo preoperatively (n = 20) for 24 h. Clinical parameters were measured before and after administration. Any adverse events during and after drug administration and postoperative complications were evaluated.

Results: Patients treated with levosimendan exhibited a higher cardiac index and mean arterial pressure intraoperative and in the early postoperative period, compared to the control group. Patients treated with levosimendan required less ventilatory support (p < 0.0001) and had shorter intensive care unit (p < 0.0001) and hospital stay (p < 0.0001).

Conclusions: Preoperative treatment with levosimendan in patients undergoing coronary artery bypass grafting and mitral valve repair resulted in improved hemodynamics and a stable postoperative course.

Keywords: Cardiac valve annuloplasty; Cardiopulmonary bypass; Cardiotonic agents; Coronary artery bypass; Levosimendan; Ventricular function.