engleski

Pretreatment with Levosimendan Improves Heart Function in Coronary Artery Bypass Grafting

OBJECTIVE. Calcium sensitizer levosimendan induces contractility by binding to troponin C without increasing intracellular calcium concentration. We tested the hypothesis that levosimendan could produce early and prolonged beneficial effect on left ventricular (LV) systolic function in patients with preoperative impaired LV function undergoing coronary artery bypass grafting (CABG). METHODS. After induction in anesthesia, patients randomized in three groups: low-dose levosimendan, high-dose levosimendan or placebo group. Levosimendan used with loading dose at low-dose (6 g/kg), high-dose (12 g/kg), or placebo were administered in thirty-one patients. Cardiac output (CO) measured with pulmonary artery catheter using bolus thermodilution method. Numerical data were described by median. For comparing the data between the independent groups (low-dose, high-dose levosimendan and placebo) the Kruskal-Walis test was applied. To compare time points within one group, testing of the differences in time within each group performed with the Friedman test. RESULTS. Increasing of CO was statistically significant and occurred both after low-dose (p = 0.001) and high-dose levosimendan (p < 0.001). Comparing values of CO between groups of patients who received low-dose levosimendan and placebo, CO was higher in low- dose levosimendan group, but statistically differences were insignificant. Furthermore, in patients who received low-dose levosimendan, compared with baseline measurement, values of CO were increased 20 minutes after infusion (p = 0.080) and 48 h after surgery (p=0.067). Similar changes in CO values have seen in group of patients who received high-dose levosimendan measured in the same time intervals. Significantly higher values of CO was in patients who received high-dose levosimendan compared with those receiving placebo, 20 min after infusion (p = 0.021) and 48 h after surgery (p = 0.006). Finally, patients treated with high-dose levosimendan, had all values of CO significantly higher when compared with baseline measurement (p = 0.005 for all). CONCLUSION. In this study, results shown that levosimendan produced significant both early and prolonged favorable effect on left ventricular output in patients with preoperative impaired LV function undergoing CABG surgery, and this effect is dose dependent. Category: Clinical Science

levosimendan; heart function; CABG

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