Comparison of Levosimendan versus Dobutamine in Patients with Moderate to Severe Left Ventricular Dysfunction Undergoing Off-pump Coronary Artery Bypass Grafting: A Randomized Prospective Study

Abstract

Context:Recent upsurge in referral of patients with compromised left ventricular (LV) function for cardiac surgery has led to an increasing use inotropes to achieve improvement of tissue perfusion in the perioperative period.Aims and Objectives:To compare the hemodynamic effects and immediate postoperative outcomes with levosimendan and dobutamine in patients with moderate to severe LV dysfunction undergoing off-pump coronary artery bypass grafting (OPCAB).Settings and Design:University teaching hospital, randomized control study.Materials and Methods:Eighty patients were randomly divided into two groups of 40 each. Group I received levosimendan at 0.1 μg/kg/min and Group II received dobutamine at 5 μg/kg/min. Hemodynamic data were noted at 30 min, during obtuse marginal grafting, 1, 6, 12, and 24 h after surgery. Heart rate (HR), mean arterial pressure (MAP), pulmonary capillary wedge pressure (PCWP), cardiac index (CI), systemic vascular resistance index (SVRI) and pulmonary vascular resistance index (PVRI), left ventricular stroke work index (LVSWI) and right ventricular stroke work index (RVSWI), mixed venous oximetry (SvO2), and lactate were measured.Statistical Analysis Used:Chi-square and Student's t-test.Results:The HR, MAP, PCWP, SVRI, and PVRI were lower in Group I when compared to Group II. Group I patients showed a statistically significant increase in LVSWI, RVSWI, and CI, when compared to Group II. Comparatively, Group I patients maintained higher SvO2 and lower lactate levels. Duration of ventilation, Intensive Care Unit (ICU), and hospital stay were lower in Group I.Conclusions:Levosimendan was associated with statistically significant increase in indices of contractility (CI, LVSWI, and RVSWI) and decrease in PCWP during and after OPCAB. Levosimendan group had lower incidence of atrial fibrillation, shorter length of ICU, and hospital stay.

Prophylactic preoperative levosimendan for off-pump coronary artery bypass grafting in patients with left ventricular dysfunction: Single-centered randomized prospective study

“…Kandasamy et al . [ 18 ] also observed reduced requirement of mechanical circulatory support in their patients. We did not find any difference in terms of ICU and hospital stay unlike other studies[ 32 33 34 ] which have documented shorter stay, and we also believe that surgical expertise, minimal handling of heart, and short anastomoses time might have contributed in this regard.…”

“…Although there is a sparse literature on the regarding use of levosimendan during cardiac surgery in patients with low EF, our results are in agreement with the available recent studies. [ 17 18 ]…”

“…Immediate postoperative outcomes also improved in levosimendan group with notably reduced incidence of POAF which can be attributed to antioxidant and anti-inflammatory properties of levosimendan. [ 18 24 25 26 ]…”

Effect of Levosimendan Infusion 24 Hours Before CABG Surgery in Patients with Impaired Left Ventricular Function on the Need for Postoperative IABP

“…Actually Levosimendan was shown in some studies to improve hemodynamics when given in small doses in patients undergoing Offpump CABG surgery. [15][16]…”

Levosimendan for Perioperative Cardioprotection: Myth or Reality?

“…Overall we found 54 relevant studies on perioperative levosimendan in cardiac surgery: 36 RCTs [17-19, 44-76], 6 retrospective studies [77-82], 7 meta-analyses [82-87, 93] and 5 consensus documents [89-93]. Studies were performed in an interval of time ranging from December 2004 to August 2017.…”