Sol ventrikül fonksiyonları bozulmuş, ejeksiyon fraksiyonu %40’ın altında olan, koroner arter by-pass greft operasyonu yapılacak hastalara verilen levosimendan tedavisinin, kardiyoprotektif etkinliğinin postoperatif olarak değerlendirilmesi

Abstract

The purpose of this study is to demonstrate the postoperative cardioprotective efficacy of preoperative levosimendan treatment in patients with impaired left ventricular function undergoing coronary by-pass surgery. Materyal and Method: This study was performed prospectively between November 2008 and September 2009 in Eskişehir Osmangazi Univercity Department of Cardiovascular Surgery. Twenty patients with coronary artery disease (CAD) between the ages of 48-78 and ejection fraction (EF) below 40% were included in the study. levosimendan was given to the first group preoperatively(experimental group). Group 2 was the control group. Coronary artery bypass graft (CABG) surgery was performed in all of them. One group received additional levosimendan infusion, preoperatively. Age, comorbidity, cardiopulmonary by-pass (CPB) time, cross clamp (CC) time, patient vessel number, anastomosis number, extubation times, intensive care stay and hospital stay were recorded. Preoperative, postoperative 1st day and postoperative 7th day nt-proBNP values and preoperative and postoperative 15th day ejection fraction (EF) values with echocardiography (ECHO) were measured. The cardioprotective efficacy of the drug was evaluated by comparing the data of the control group and the experimental group. Results: No statistically significant difference was found between the two groups in terms of CPB time, CC time, age, comorbidity, number of sick vessels, number of anastomosis, extubation time, length of stay in intensive care and hospital stay. (P> 0.05). There was no significant difference between the groups in preoperative EF values (P> 0.05). The mean values of EF measurements on the postoperative 15th day were calculated as 39% in the experimental group and 40% in the control group. The increase in EF values was greater in the experimental group. This increase was found to be more significant in the experimental group (P = 0.008). There was a significant difference between the groups in preoperative and postoperative 1st day n-tproBNP values (P <0.05). A significant increase was observed in nt-proBNP values in the groups until the 7th postoperative day. (P <0.001). Although this increase was statistically significant in both groups, it was observed that the increase in the control group was higher. After the nt-proBNP measurements on the postoperative 7th day, there was no significant difference between the two groups (P> 0.05). Conclusion: As a result of this study, it was determined that levosimendan has a positive effect on myocardial protection and contractility in patients with low EF in CABG surgery. Keywords: Levosimendan; coroner by-pass surgery; left ventricle dyusfunction.