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Original Articles: Adult Cardiac

Levosimendan Facilitates Weaning From Cardiopulmonary Bypass in Patients Undergoing Coronary Artery Bypass Grafting With Impaired Left Ventricular Function

^a Department of Anesthesiology and Intensive Care, Helsinki University Central Hospital, Helsinki, Finland
^c Department of Cardiothoracic Surgery, Helsinki University Central Hospital, Helsinki, Finland
^e Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
^b Department of Anesthesiology, Turku University Hospital, Turku, Finland
^f Department of Cardiovascular Surgery, Turku University Hospital, Turku, Finland
^d Orion Pharma, Cardiology Unit, Clinical Research and Development, Espoo, Finland

Accepted for publication October 8, 2008.

^_* Address correspondence to Dr Eriksson, Department of Anesthesiology and Intensive Care, Haartmaninkatu 4, Helsinki, FIN-00290 HUS, Finland (Email: heidi.eriksson{at}hus.fi).

Background: Levosimendan is a compound with vasodilatory and inotropic properties. Experimental data suggest effective reversal of stunning and cardioprotective properties.

Methods: This prospective, randomized, placebo-controlled, double-blind study included 60 patients with 3-vessel coronary disease and left ventricular ejection fraction (LVEF) of less than 0.50. Levosimendan administration (12 µg/kg bolus, followed by an infusion of 0.2 µg/kg/min) was started immediately after induction anesthesia. Predefined strict hemodynamic criteria were used to assess the success of weaning. If weaning was not successful, CPB was reinstituted and an epinephrine infusion was started. If the second weaning attempt failed, intraaortic balloon pumping (IABP) was instituted.

Results: The groups had comparable demographics. The mean (standard deviation) preoperative LVEF was 0.36 (0.8) in both groups. The baseline cardiac index was 1.8 (0.3) L/min/m² in the levosimendan group and 1.9 (0.4) L/min/m² in the placebo group. The mean duration of CPB to primary weaning attempt was 104 (25) minutes in the levosimendan and 109 (22) minutes in the placebo group. Primary weaning was successful in 22 patients (73%) in the levosimendan group and in 10 (33%) in the placebo group (p = 0.002). The odds ratio for failure in primary weaning was 0.182 (95% confidence interval, 0.060 to 0.552). Four patients in the placebo group failed the second weaning and underwent IABP compared with none in the levosimendan group (p = 0.112).

Conclusions: Levosimendan significantly enhanced primary weaning from CPB compared with placebo in patients undergoing 3-vessel on-pump coronary artery bypass grafting. The need for additional inotropic or mechanical therapy was decreased.