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

Autor: Anne Kuitunen, Markku Salmenperä, Leo O. Heikkinen, Matti Kivikko, Toni Sarapohja, Jouko Jalonen, Kari Leino, Heidi Eriksson, Mika Laine, Mika Valtonen, Tarja Peräkylä, Raili Suojaranta-Ylinen, Kari Kuttila
Rok vydání: 2009
Předmět:
Male
Cardiac index
Hemodynamics
Coronary Angiography
Severity of Illness Index
law.invention
Ventricular Dysfunction
Left
Postoperative Complications
Bolus (medicine)
Reference Values
law
Medicine
Prospective Studies
Coronary Artery Bypass
Infusions
Intravenous
Cardiopulmonary Bypass
Ejection fraction
Middle Aged
Pyridazines
Treatment Outcome
Anesthesia
Cardiology
Education
Medical
Continuing
Female
Cardiology and Cardiovascular Medicine
medicine.drug
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Placebo
Risk Assessment
Double-Blind Method
Monitoring
Intraoperative
Internal medicine
Preoperative Care
Confidence Intervals
Cardiopulmonary bypass
Humans
Weaning
Simendan
Aged
Analysis of Variance
business.industry
Coronary Stenosis
Hydrazones
Stroke Volume
Levosimendan
Survival Analysis
Surgery
business
Zdroj: The Annals of Thoracic Surgery. 87:448-454
ISSN: 0003-4975
DOI: 10.1016/j.athoracsur.2008.10.029
Popis: 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/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.
Databáze: OpenAIRE
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