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Levosimendan facilitates weaning from cardiopulmonary bypass in patients undergoing coronary artery bypass grafting
Heidi I Eriksson1, Jouko R Jalonen, Leo O Heikkinen
1Department of Anesthesiology and Intensive Care, Helsinki University Central Hospital, Helsinki, Finland. heidi.eriksson@hus.fi
Insights
Levosimendan significantly improved weaning from cardiopulmonary bypass (CPB) in patients undergoing coronary artery bypass grafting. This reduced the need for additional inotropic or mechanical support, enhancing patient recovery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pharmacology
Background:
- Levosimendan possesses vasodilatory and inotropic properties.
- Experimental studies suggest levosimendan can reverse myocardial stunning and offer cardioprotection.
Purpose of the Study:
- To evaluate the efficacy of levosimendan in facilitating weaning from cardiopulmonary bypass (CPB) after 3-vessel on-pump coronary artery bypass grafting (CABG).
Main Methods:
- A prospective, randomized, placebo-controlled, double-blind study involving 60 patients with 3-vessel coronary disease and reduced left ventricular ejection fraction (LVEF < 0.50).
- Levosimendan was administered as a bolus followed by an infusion post-anesthesia induction.
- Hemodynamic criteria assessed weaning success; failure led to CPB reinstitution, epinephrine infusion, or intraaortic balloon pumping (IABP).
Main Results:
- Primary weaning from CPB was successful in 73% of patients receiving levosimendan versus 33% receiving placebo (p = 0.002).
- The odds ratio for primary weaning failure was significantly lower in the levosimendan group (0.182).
- No patients in the levosimendan group required IABP after failed weaning attempts, compared to four patients in the placebo group (p = 0.112).
Conclusions:
- Levosimendan significantly improved primary weaning from CPB in patients undergoing 3-vessel CABG compared to placebo.
- The use of additional inotropic agents or mechanical circulatory support, such as IABP, was reduced with levosimendan administration.
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 microg/kg bolus, followed by an infusion of 0.2 microg/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/m(2) in the levosimendan group and 1.9 (0.4) L/min/m(2) 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.
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