The Effect Of Levosimendan Following Cardiac Surgery: Two Case Reports

Abstract

Difficulty of weaning off the cardiopulmonary bypass (CPB) due to postcardiotomy heart failure is a serious problem in cardiac surgeries. Levosimendan, a calcium sensitizer, has been shown to expert a positive inotropic effect without disturbing the energy balance of the heart. Levosimendan combines with troponin C in the myocardium and stabilizes the troponin C-calcium complex, without increasing th intracellular calcium level. Its action produces improved myocardial contractility and cardiac output without increasing myocardial oxygen demand. This report describes the successful use of levosimendan infusion in two cases having difficulty in weaning from CPB pump during coroner artery bypass grafting (CABG) surgery. First case scheduled for CABG surgery. A hemodynamically stable patient experienced cardiac arrest during skin closing after cardiopulmonary bypass. Resuscitation was started. The patient was taken to cardiopulmonary bypass again and cardiac pace marker was implanted. Hemodynamic stability was failed after dobutamin and dopamine infusions. The patient couldn't be weaned of cardiopulmonary bypass and intraaortic balloon pump was administered. Levosimendan treatment was the next step. The patient was weaned off cardiopulmonary bypass after starting levosimendan treatment. A second case CABG operation was performed by routine surgical procedure dobutamine and dopamine were both started during cardiopulmonary bypass. Cardiac pacemaker was implanted to the patient considering his cardiac rhythm as A-V block. Intraaortic balloon pomp was administered because of his hemodynamic failure. Despite this supportive treatment the patient failed to achieve adequate hemodynamic stability. The patient was weaned off cardiopulmonary bypass 40 minutes after starting levosimendan treatment.