TY - JOUR

T1 - Levosimendan versus an intra-aortic balloon pump in high-risk cardiac patients

AU - Lomivorotov, Vladimir V.

AU - Boboshko, Vladimir A.

AU - Efremov, Sergey M.

AU - Kornilov, Igor A.

AU - Chernyavskiy, Alexandr M.

AU - Lomivorotov, Vladimir N.

AU - Knazkova, Lubov G.

AU - Karaskov, Alexander M.

PY - 2012/8/1

Y1 - 2012/8/1

N2 - Objective: To test the hypothesis that levosimendan is more effective than intra-aortic balloon pump (IABP) support in cardiac surgical patients with low left ventricular ejection fraction to decrease cardiac troponin I levels (primary endpoint) and improve hemodynamics. Design: Prospective randomized trial. Setting: Tertiary cardiothoracic referral center. Participants: Ninety patients with coronary artery disease and left ventricular ejection fraction <35% who underwent surgery with cardiopulmonary bypass. Intervention: Patients were assigned randomly to 1 of 3 groups. Group A received a prophylactic IABP one day before surgery. Group B received a prophylactic IABP one day before surgery and a levosimendan infusion at a dose of 0.1 μg/kg/min with an initial bolus (12 μg/kg for 10 minutes) after anesthesia induction. Group C received a levosimendan infusion at a dose of 0.1 μg/kg/min with an initial bolus (12 μg/kg for 10 minutes) after anesthesia induction. Hemodynamic and biochemical data and rate of complications were analyzed. Measurements and Main Results: The cardiac troponin I level in group C 6 hours after surgery was lower than in group A (p = 0.048). The cardiac index in group A was significantly lower than in groups B and C. The intensive care unit stay was significantly shorter in group C than in groups A and B (p = 0.001). The need for inotropic support, the rate of complications, and mortality among groups did not differ. Conclusions: The infusion of levosimendan after anesthesia induction in cardiac surgical patients contributes to lower cardiac troponin I levels and improved hemodynamics compared with a preoperative IABP.

AB - Objective: To test the hypothesis that levosimendan is more effective than intra-aortic balloon pump (IABP) support in cardiac surgical patients with low left ventricular ejection fraction to decrease cardiac troponin I levels (primary endpoint) and improve hemodynamics. Design: Prospective randomized trial. Setting: Tertiary cardiothoracic referral center. Participants: Ninety patients with coronary artery disease and left ventricular ejection fraction <35% who underwent surgery with cardiopulmonary bypass. Intervention: Patients were assigned randomly to 1 of 3 groups. Group A received a prophylactic IABP one day before surgery. Group B received a prophylactic IABP one day before surgery and a levosimendan infusion at a dose of 0.1 μg/kg/min with an initial bolus (12 μg/kg for 10 minutes) after anesthesia induction. Group C received a levosimendan infusion at a dose of 0.1 μg/kg/min with an initial bolus (12 μg/kg for 10 minutes) after anesthesia induction. Hemodynamic and biochemical data and rate of complications were analyzed. Measurements and Main Results: The cardiac troponin I level in group C 6 hours after surgery was lower than in group A (p = 0.048). The cardiac index in group A was significantly lower than in groups B and C. The intensive care unit stay was significantly shorter in group C than in groups A and B (p = 0.001). The need for inotropic support, the rate of complications, and mortality among groups did not differ. Conclusions: The infusion of levosimendan after anesthesia induction in cardiac surgical patients contributes to lower cardiac troponin I levels and improved hemodynamics compared with a preoperative IABP.

KW - cardiac surgery

KW - coronary artery bypass grafting

KW - intra-aortic balloon pump

KW - levosimendan

UR - http://www.scopus.com/inward/record.url?scp=84863442766&partnerID=8YFLogxK

U2 - 10.1053/j.jvca.2011.09.006

DO - 10.1053/j.jvca.2011.09.006

M3 - Article

C2 - 22051419

AN - SCOPUS:84863442766

VL - 26

SP - 596

EP - 603

JO - Journal of Cardiothoracic and Vascular Anesthesia

JF - Journal of Cardiothoracic and Vascular Anesthesia

SN - 1053-0770

IS - 4

ER -