Levosimendan in patients with low ejection fraction undergoing cardiac surgery

Introduction
Significant impairment of left ventricular function causes low cardiac output syndrome in the immediate postoperative period in 3–14% of patients undergoing surgery, increasing the mortality 15-fold.

Aim
To assess the use of levosimendan in patients undergoing cardiac surgery in 2016.

Material and methods
The analysis included 14 patients: 3 (21.4%) women and 11 (78.6%) men aged 65.4 ±11.8 years. The mean value of left ventricular ejection fraction amounted to 20 ±6.25%. In 11 patients, levosimendan infusion was started immediately after the induction of anesthesia. Three patients received the agent during the early postoperative period due to low cardiac output syndrome refractory to conventional therapy. The dosage was modified within the range of 0.05–0.2 g/kg/min. On the day of the surgery, all patients received continuous infusion of adrenaline and levonor.

Results
The cardiac index amounted to 2.8 ±0.71 l/m² after several hours of infusion and 2.9 ±0.1 l/m² the next morning. The first examination showed that the mean systemic vascular resistance was 1010 dyn/s–5 and the second: 940 ±100 dyn/s–5; mixed venous blood saturation amounted to 66 ±7.5% and 65.5 ±8%, respectively. Respectively, the mean concentration of lactates was 2.0 ±0.96 mmol/l and 1.8 ±0.24 mmol/l. Mechanical lung ventilation lasting more than 48 hours was required in 50% of the patients. Two patients with chronic kidney disease required bedside renal replacement therapy before the procedure. Two (14.3%) patients died. Nine (64.3%) patients were discharged home, and three were transferred to cardiac wards.

Conclusions
Levosimendan therapy proved safe in the study group. The nature of the study and the small sample size preclude the formulation of detailed conclusions.