EFFECT OF LEVOSEMINDAN ON OUTCOME OF CORONARY ARTERY BYPASS GRAFTING SURGERY IN PATIENT WITH IMPAIRED LEFT VENTRICULAR SYSTOLIC FUNCTION

Abstract

Background: Coronary artery bypass grafting (CABG) is often complicated by hemodynamic instability, especially in cases with decreased left ventricular ejection fraction (LVEF). Levosimendan as inotropic agent can be used in those patients. Objective: To assess morbidity and mortality rates up to 6 months following CABG surgery in patients with LVEF equals 35%, who were given Levosimendan. Patients and methods: 40 patients with preoperative LVEF ≤ 35% underwent elective CABG were retrospectively analyzed between March 2020 and April 2022 at Al-Azhar University Hospitals. Levosemindan was used in continuously-given bolus-free infusion at a range from 0.05 to 0.2 ug/kg/min prior surgery. Hemodynamic and outcome parameters were registered and statistically analyzed. Results: A significant improvement was recorded in EF% from 32.8% to 35.9% then 39.4% after one week and 6 months respectively; it was associated with significant increase in cardiac output from 5.22 liter per minute to 6.3 L/min and 6.1 L/min after one week and 6 months respectively. MAP was also increased from 63.44 mmHg to 80.4 mmHg and 84.6 mmHg after one week and 6 months respectively. 80% of patients showed no complications; on the other hand, 5% of them had low cardiac output syndrome (LCOS), 5% needed IABP, 5% rapid AF, and 5% needed reoperation due to bleeding. On the other hand, postoperative (later) complications included the following: severe sternal wound infection in 2 cases (5%), and chronic AF in one case (2.5%); the overall mortality rate was 10%. Conclusion: levosimendan has a beneficial effect in improving hemodynamic state; in addition, it aids the reduction of hospital and ICU stays, along with the ability to reduce the incidence of LCOS and mortality rate.