BJA Advance Access originally published online on April 4, 2006
British Journal of Anaesthesia 2006 96(6):694-700; doi:10.1093/bja/ael082
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Preconditioning effects of levosimendan in coronary artery bypass grafting—a pilot study
1 Department of Anesthesiology and Intensive Care, University of Rome ‘La Sapienza’ Rome, Italy
2 Department of Cellular Biotechnology and Haematology, University of Rome ‘La Sapienza’ Rome, Italy
3 Department of Experimental Medicine and Pathology, University of Rome ‘La Sapienza’ Rome, Italy
4 VOC di Biotecnologie Applicate alle Malattie Cardiovasculari, Department of the Heart and Great Vessels ‘Attilio Reale’, University of Rome ‘La Sapienza’ Rome, Italy
5 Bloomsbury Institute of Intensive Care Medicine, University College London London, UK
*Corresponding author: Via Clementina 11, 00184 Rome, Italy. E-mail: vincenzo.desantis{at}uniroma1.it
Background. The calcium sensitizer levosimendan protects against myocardial ischaemia and reperfusion injury in animal models.
Methods. The present pilot study investigated whether a short infusion before coronary artery bypass grafting (CABG) would protect the myocardium and improve postoperative haemodynamics. Twenty-four patients with stable angina undergoing elective CABG surgery were randomized to receive either placebo or levosimendan (24 µg kg–1) infused i.v. over a 10 min period just before placing the patient on cardiopulmonary bypass.
Results. Perioperative haemodynamic variables, concentrations of cardiac troponin I over the 48 h postoperative period, and clinical outcomes were assessed. There were no adverse effects related to levosimendan. Compared with control patients, levosimendan-treated patients had lower postoperative troponin I concentrations (P<0.05) and a higher cardiac index (P<0.05).
Conclusion. Patients receiving a short infusion of levosimendan before CABG showed evidence of less myocardial damage, suggestive of a preconditioning effect. Larger outcome studies are thus indicated to confirm benefit.
Declaration of interest. M.S. has sat on advisory boards for levosimendan on behalf of Orion, the manufacturer, and Abbott, the distributor. He has also received honoraria for chairing/speaking at satellite symposia and for co-editing a website, failinghears.com, supported by an unrestricted educational grant from Abbott.
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