Levosimendan In Cardiology and Cardiac Surgery

Abstract

Introduction: levosimendan is an inodilator successfully used in the treatment of acute and chronic heart failure. Its use in the treatment of low cardiac output syndrome pre- and postoperatively after cardiac surgery under extracardiac circulation is poorly documented, but it appears to be a very interesting alternative in terms of morbimortality. Aim of the study: to evaluate the value of levosimendan versus dobutamine in the rapid weaning of inotropic drugs in low output patients awaiting cardiac surgery and after surgery under extracorporeal circulation. Materials and methods: sixty patients with low cardiac output syndrome before surgery on levosimendan and after cardiac surgery on extracorporeal circulation, requiring positive inotropic and vasopressor drugs (dobutamine ± noradrenaline). Post-operatively, in the context of drug weaning, we identified two groups : levosimendan group (n=30) and dobutamine group (n=30). In the levosimendan group, dobutamine was replaced immediately postoperatively by levosimendan. Hemodynamic parameters (MAP, HR, CI, ESV, SVR), ICU length of stay and 30-day mortality were assessed and compared between the two groups of patients. Results: Cardiac index was significantly higher in the levosimendan group than in the dobutamine group (2.8 [0.3] l/min/m² versus 2.3 [0.4] ml/min/m²) respectively, P Conclusion: the use of levosimendan in the treatment of low cardiac output syndrome before and after cardiac surgery with extracorporeal circulation resulted in rapid improvement in hemodynamic status with a short intensive care unit stay and low mortality.