Levosimendan pre-treatment improves outcomes in patients undergoing coronary artery bypass graft surgery
1 Department of Anesthesiology and Intensive Care, ‘Sapienza’ University of Rome, Rome, Italy
2 Cardiothoracic Department, Cardiothoracic Anesthesia and Intensive Care Unit, University Hospital of Pisa, Pisa, Italy
3 Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Santa Maria Imbaro, Chieti, Italy
4 Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK
* Corresponding author. E-mail: vincenzo.desantis{at}uniroma1.it
Background: The calcium sensitizer levosimendan has anti-ischaemic effects mediated via the opening of sarcolemmal and mitochondrial ATP-sensitive potassium channels. These properties suggest potential application in clinical situations where cardioprotection would be beneficial, such as cardiac surgery. We thus decided to investigate whether pharmacological pre-treatment with levosimendan reduces intensive care unit (ICU) length of stay in patients undergoing elective myocardial revascularization under cardiopulmonary bypass.
Methods: One hundred and six patients undergoing elective coronary artery bypass grafting were randomly assigned in a double-blind manner to receive levosimendan or placebo. Levosimendan (24 µg kg–1) or placebo was administered as a slow i.v. bolus over a 10 min period before the initiation of bypass.
Results: Tracheal intubation time and the length of ICU stay were significantly reduced in the levosimendan group (P<0.01). The number of patients needing inotropic support for >12 h was significantly higher in the control group (18.0% vs 3.8%; P=0.021). Compared with control patients, levosimendan-treated patients had lower postoperative troponin I concentrations (P<0.0001) and a higher cardiac power index (P<0.0001).
Conclusions: Pre-treatment with levosimendan in patients undergoing surgical myocardial revascularization resulted in less myocardial injury, a reduction in tracheal intubation time, less requirement for inotropic support, and a shorter length of ICU stay.
Keywords: heart, coronary artery bypass; heart, inotropism; heart, ischaemia; surgery, cardiovascular
Trial registration: clinicaltrials.gov identifier: nCT00610350
[ClinicalTrials.gov]
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Declaration of interest. L.T., F.G., and M.S. have sat on advisory boards for levosimendan on behalf of Orion, the manufacturer, and Abbott, the distributor. They have also received honoraria for chairing/speaking at satellite symposia.
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