Comparison of Levosimendan Versus IABP in Patients with Poor Left Ventricular Function Undergoing Coronary Artery Bypass Graft Surgery

Abstract

<jats:p>Objectives: The aim of this study was to compare the use of levosimendan versus intra-aortic balloon pump (IABP) in patients with poor left ventricular function undergoing coronary artery bypass grafting (CABG) with ejection fraction less than 35%.&#x0D; Methods: Between February 2016 and March 2019, a prospective randomized study was performed on a group of 279 consecutive patients with left ventricular ejection fraction &lt; 35%, who underwent elective CABG without concomitant procedures. These patients were divided into 2 groups, according to the treatment they received – either levosimendan (Group A) or intra-aortic balloon counterpulsation (Group B).&#x0D; Results: There was no statistically significant difference between the 2 groups, regarding mortality and morbidity. In the IABP group, the mean arterial blood pressure (2 hours post cardiopulmonary bypass) significantly was higher, and the heart rate in postoperative Day 1 significantly was lower. The levosimendan group had a significantly lower ICU stay than the IABP group.&#x0D; Conclusion: We found that starting levosimendan infusion after induction of anesthesia is an acceptable option in comparison to IABP. The use of levosimendan in high-risk cardiac patients is comparable to IABP in improving hemodynamics during and after conventional on-pump CABG and results in a shorter ICU stay. </jats:p>

Comparison between Intra-Aortic Balloon Pump and Levosimendan as Treatment Modalities for Cardiogenic Shock Post Cardiac Surgery

“…This result agrees with Mate et al, [11] which showed that length of ICU stay in levosimendan group was 4.4±0.2 days and 6.5±0.1 days with IABP and this was statistically significant (P value <0.001). This result also agrees with Omar et al, [13] which showed that length of ICU stay in levosimendan group was 4.4±0.8 days and 5.2±0.9 days with IABP and this was statistically significant (P value <0.005).…”

“…These results can be explained by frequent complications of IABP as an invasive procedure like bleeding and infection or anticoagulation related like serious bleeding or thrombocytopenia or HIT as shown in table 4. That finding agrees with Severi et al [12] and Omar et al [13] where P value was 0.3 and 0.6 respectively when mortality was compared between two groups. This finding disagrees with Treskatsch et al [14] which enrolled 159 patients with low cardiac output syndrome post-operative to assess the effects on postoperative outcome of levosimendan and showed that significant reduction of mortality with levosimendan compared with conventional therapy (P value = 0.04).…”

“…P value was 0.8. These findings also agree with Omar et al, [13] which compares the use of levosimendan versus intra-aortic balloon pump (IABP) in patients with poor left ventricular function undergoing CABG. They enrolled 279 patients and divided them into two groups according to treatment received and showed that mean post-operative LVEF was 38.7±4.6 in IABP group and 34.2±2.1 in levosimendan with no statistical difference.…”

Comparative study between levosimendan and intra-aortic balloon pump in high risk patients undergoing beating heart coronary artery bypass surgery

“…The mortality rate among IABP and Levosimendan group in current study, was 10% and 5% respectively with no statistically significant difference between them (p>0.05). In a line with current findings, primary results from a randomized clinical trial by Omar et al 18 study conducted in 279 consecutive patients with LVEF < 35% undergoing CABG surgery identified no significant difference in mortality rate between patients who received 0.1 μg/kg/min levosimendan for 24 h and those assigned to an IABP, although the length of ICU stay was shorter in the levosimendan group (4.4 vs 5.2 days; p = 0.05).…”

Levosimendan in intensive care and emergency medicine: literature update and expert recommendations for optimal efficacy and safety

“…Primary results from a randomized clinical trial conducted in 279 consecutive patients with LVEF < 35% undergoing CABG surgery identified no significant difference in mortality rate between patients who received 0.1 μg/kg/min levosimendan for 24 h and those assigned to an IABP, although the length of ICU stay was shorter in the levosimendan group (4.4 vs 5.2 days; p = 0.05) [ 12 ]. The use of levosimendan in high-risk cardiac patients was thus comparable to that of an IABP, with implications for cost of care.…”