Comparison between Intra-Aortic Balloon Pump and Levosimendan as Treatment Modalities for Cardiogenic Shock Post Cardiac Surgery

Abstract

Purpose: Post cardiac surgery cardiogenic shock is one of the major life threatening complications of open heart surgeries. Two modalities are widely used to improve the cardiac output and overcome the acute postoperative complication beside other conventional treatment including mechanical ventilator, inotropes and vasopressors. Those modalities are levosimendan and Intra-aortic balloon pump. The purpose of this study is to investigate the prognosis of levosimendan vs IABP in patients who developed cardiogenic shock post cardiac surgery.
 Methodology: This was a prospective observational study conducted as national heart institute, Egypt on 50 patients who developed cardiogenic shock post cardiac surgery and managed by either levosimendan or Intra-aortic balloon Pump (IABP) beside other conventional therapies. Patients were then divided into two groups according to the modality used. Group I: patients who were managed by levosimendan and group II: patients who were managed by IABP. Two groups were then compared according to baseline preoperative characteristics and in-hospital course and one month follow up post discharge echocardiography.
 Findings: No significant difference regarding between in-hospital mortality between levosimendan, 44% and IABP, 52% P value 0.5. Levosimendan was associated with significantly shorter ICU stay, 5.56±2.85 compared to IABP, 8±3.34 days (P value 0.02). Levosimendan seems to be a better option than IABP or at least equivalent to it in postoperative cardiogenic shock.
 Recommendations: Levosimendan is an alternative cost effective modality for patients with post-operative low cardiac output syndrome especially when IABP isn’t available.