Related Experiment Video
Updated: Dec 27, 2025
Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
Published on: August 16, 2021
Comparison of Levosimendan Versus IABP in Patients with Poor Left Ventricular Function Undergoing Coronary Artery
Alaa Omar1, Mahmoud Eldegwy1, Mohamed Allam1
1Cardiothoracic Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
Insights
Levosimendan is a viable alternative to intra-aortic balloon pumps (IABP) for patients undergoing coronary artery bypass grafting (CABG) with reduced left ventricular function, offering comparable outcomes and a shorter ICU stay.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pharmacology
Background:
- Patients with poor left ventricular function (ejection fraction < 35%) undergoing coronary artery bypass grafting (CABG) represent a high-risk group.
- Optimizing hemodynamic support during and after CABG is crucial for this patient population.
Purpose of the Study:
- To compare the efficacy and safety of levosimendan versus intra-aortic balloon pump (IABP) in patients with severely impaired left ventricular function undergoing CABG.
- To evaluate the impact of these interventions on mortality, morbidity, hemodynamic parameters, and intensive care unit (ICU) length of stay.
Main Methods:
- A prospective randomized study involving 279 patients with ejection fraction < 35% undergoing elective CABG.
- Patients were randomized to receive either levosimendan (Group A) or IABP (Group B).
- Outcomes including mortality, morbidity, hemodynamic status, and ICU stay were assessed.
Main Results:
- No statistically significant differences in mortality or morbidity were observed between the levosimendan and IABP groups.
- The IABP group showed a significantly higher mean arterial blood pressure post-cardiopulmonary bypass and a lower heart rate on postoperative Day 1.
- The levosimendan group experienced a significantly shorter ICU stay compared to the IABP group.
Conclusions:
- Levosimendan infusion initiated after anesthesia induction is an acceptable alternative to IABP in high-risk cardiac surgery patients.
- Levosimendan demonstrates comparable hemodynamic support to IABP during and after on-pump CABG.
- The use of levosimendan in this cohort leads to a reduced ICU length of stay.
Objectives:
The aim of this study was to compare the use of levosimendan versus intra-aortic balloon pump (IABP) in patients with poor left ventricular function undergoing coronary artery bypass grafting (CABG) with ejection fraction less than 35%.
Methods:
Between February 2016 and March 2019, a prospective randomized study was performed on a group of 279 consecutive patients with left ventricular ejection fraction < 35%, who underwent elective CABG without concomitant procedures. These patients were divided into 2 groups, according to the treatment they received - either levosimendan (Group A) or intra-aortic balloon counterpulsation (Group B).
Results:
There was no statistically significant difference between the 2 groups, regarding mortality and morbidity. In the IABP group, the mean arterial blood pressure (2 hours post cardiopulmonary bypass) significantly was higher, and the heart rate in postoperative Day 1 significantly was lower. The levosimendan group had a significantly lower ICU stay than the IABP group.
Conclusion:
We found that starting levosimendan infusion after induction of anesthesia is an acceptable option in comparison to IABP. The use of levosimendan in high-risk cardiac patients is comparable to IABP in improving hemodynamics during and after conventional on-pump CABG and results in a shorter ICU stay.
