The Effect of Pre-Operative Prophylactic Levosimendan “A Calcium Sensitizer” for on Pump Coronary Artery Bypass Grafting in Patients with Low Ejection Fraction | Chapter 10 | Issues and Developments in Medicine and Medical Research Vol. 6

 Background: On-pump CABG is associated with more complete revascularization than OPCAB, but the use of a CPB Machine is associated with a severe inflammatory response, which can lead to adverse effects, especially in patients with a low ejection fraction. Appropriate inotrope selection is critical in the perioperative management of these patients.

Aim and Objective: To investigate the effects of Levosimendan when given prophylactically in the perioperative period in patients undergoing On Pump CABG who have a poor ejection fraction.

Materials and Methods: After receiving written informed consent and receiving clearance from the Institutional Ethics Committee, 60 patients undergoing elective On Pump CABG were randomly allocated into two groups (n=30 each). Hemodynamic parameters such as Heart Rate, Invasive Blood Pressure, Pulmonary Capillary Wedge Pressure (PCWP), Cardiac Index (CI), Pulse Oximetry, Nasopharyngeal Temperature Capnography, Urine Output, and Arterial Blood Gas including Serum Lactate were monitored at To (baseline), T1 (15 minutes after OM & PDA anastomoses), T2 (at end of surgery), T3 (6 hours after ( 24 hrs after surgery).

In comparison to group B, CI was much higher and PCWP was significantly lower in group A. When compared to group A, group B had a considerably lower MAP at T1 and a significantly higher number of patients who suffered Acute Kidney Injury. When compared to group B, patients in group A had less POAF and needed less IABP.

Conclusion: Prophylactic preoperative Levosimendan is related with fewer hemodynamic disturbances and a better clinical outcome in patients with low ejection fraction who are receiving On Pump CABG.

Author(S) Details

Satish Kumar Mishra
Department of Cardiothoracic Anesthesia, Military Hospital (CTC), Pune, Maharashtra, India.

Sachin Shouche
Department of Cardiothoracic Anesthesia, Military Hospital (CTC), Pune, Maharashtra, India.

B. S. Sethi
Department of Cardiothoracic Anesthesia, Military Hospital (CTC), Pune, Maharashtra, India.

H. S. Sidhu
Department of Cardiothoracic Anesthesia, Military Hospital (CTC), Pune, Maharashtra, India.

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