Successful Use of Levosimendan in a Patient During Cardiopulmonary Bypass

Abstract

Levosimendan (LS) is a novel calcium sensitizer drug that enhances cardiac contractility without increasing myocardial oxygen consumption, and induces vasodilatation. Positive inotropic support is routinely used for weaning from cardiopulmonary bypass circulation in patients with reduced left ventricular function. This case report represents the successful usage of LS for weaning from cardiopulmonary bypass circulation after coronary artery bypass surgery. Levosimendan infusion was started at the sixth hour of cardiopulmonary bypass circulation. There was a dramatic increase in cardiac output 20 minutes after LS infusion, and weaning from cardiopulmonary bypass circulation was achieved. We suggest that LS enhances cardiac performance during and after cardiopulmonary bypass, and can be useful for patients who are unable to be weaned from cardiopulmonary bypass.

Use of levosimendan in patients with ischemic heart disease following mechanical reperfusion

“…In one study, Levosimendan given at the 6th hour of cardiopulmonary bypass is reported to result in a dramatic improvement in the cardiac output. 22 In an isolated mouse heart in which cold cardioplegic arrest was induced following global hypothermic ischemia, levosimendan was found to provide better cardioprotection in comparison to the control group. 19 In another similar study in patients with acute left ventricular dysfunction who experienced diffi culties during pump detachment following cardiopulmonary bypass (CABG), the administration of levosimendan was found to be useful and its positive contribution to surgery was observed to persist even if initiated preoperatively.…”

Ist alles sinnvoll, was machbar ist?

“…Sowohl Prä-als auch Postkonditionierung [1,20] sowie ein Reduzierung der Infarktgröße sind beschrieben [20]. Erfolgreiche Berichte über dessen Einsatz in der Herzchirurgie [6,8,11] lassen eine zunehmende Verwendung bei diesen Patienten erwarten (Übersicht bei [10,15] Ein guter Anästhesist und die patientenbezogen richtige Auswahl der Anästheti-ka erlauben eine schonende Allgemeinanästhesie und ihre Beendigung am Operationsende. Eine vergleichbare Diskussion hat sich übrigens auch bei der Beurteilung der anästhesiologischen Versorgung beim transfemoralen Aortenklappenersatz entwickelt.…”