Levosimendan for Weaning from Cardiopulmonary Bypass after Coronary Artery Bypass Grafting☆

Background

Although cathecholamines are well-established agents of myocardial support during weaning from cardiopulmonary bypass (CPB), there has been little experience with a new inotropic agent, levosimendan. Our aim was to present our experience with levosimendan usage in patients manifesting failure-to-wean from CPB after coronary artery bypass grafting (CABG) when conventional inotropic and intraaortic balloon counterpulsation (IABP) therapies proved to be insufficient.

Methods

Fifteen patients undergoing CABG received levosimendan as a loading dose of 12–24μg/kg over 10min, followed by a continuous infusion of 0.1–0.2μg/(kgmin) for 24h. Hemodynamic measurements were performed at baseline and at 1, 24 and 48h postoperatively.

Results

Mean patient age was 63.2±2.2 years. CPB time was 149.7±19.5min, while cross-clamp time was 67.8±10.5min. All patients showed evidence of hemodynamic improvement with the start of levosimendan infusion and 14 patients (93.3%) were successfully weaned from CPB. Eight patients (53.3%) experienced significant increases in cardiac index and blood pressure leading to a lessening of the need for catecholamine support. Five patients (33.3%) were lost postoperatively in the ICU.

Conclusion

Levosimendan appears to be useful in failure-to-wean from CPB after cardiotomy when conventional inotropic therapy proves inadequate.

Keywords: Levosimendan, Coronary artery bypass grafting, Cardiopulmonary bypass, Inotropes, Cardiac surgery