The Use of Prophylactic Levosimendan in Patients with Left Ventricular Dysfunction Under Off-pump Coronary Artery Bypass Graft Surgery

Levosimendan is a calcium sensitive inotrope and ATP-sensitive potassium channel opener that is effective in the prevention and treatment of low cardiac output syndrome (LCOS) after cardiac surgery. The purpose of this study was to investigate the need for inotrope during ICU admission, the incidence of myocardial infarction within 3 days after surgery, the need for insertion of intra-aortic balloon pump within 3 days after surgery, and examining the time of extubation of the endotracheal tube and the time of discharge from the ICU. In this randomized clinical trial, 60 patients with mean age of 65 years with left ventricular ejection fraction (% 30 ≥) (LVEF), who were candidates of off pump coronary artery bypass graft surgery were examined.Patients were screened for 20 days before surgery and those with renal insufficiency or liver failure as well as those who simultaneously needed to use inotropic or vasopressor drugs or were candidates for cardiac surgery using a cardiopulmonary pump were excluded. Patients were randomly divided into experimental and control groups. After insertion of the arterial catheter and simultaneously with the skin incision in the experimental group, intravenous prophylactic levosimendan (0.1μg / kg / min) was used from the start of surgery to 24 hours after surgery. The control group did not receive any inotrope. For statistical analysis of data U Mann-Whitney test and Chi-square test were used (P< 0.05). The use of levosimendan had no significant effect on the time of extubation of the endotracheal tube in the ICU (p = 0.336); Also, levosimendan had no significant effect on the time of discharge of patients from ICU (p = 0.292). However, the use of levosimendan had a significant effect on the need for insertion of intra-aortic balloon pump (IABP) (p = 0.038) as well as the incidence of myocardial infarction (p <0.001), and reduced the incidence of myocardial infarction (p=0.001) and the percentage of need for insertion of intra-aortic balloon pump (IABP).) (p = 0.038). According to findings of the present study, it is recommended to use levosimendan to reduce the incidence of myocardial infarction and reduce the need for insertion of intra-aortic balloon pump in patients with left ventricular dysfunction in off pump coronary artery bypass graft surgery.