USE OF LEVOSIMENDAN TO TREAT SEVERE HEART FAILURE IN PATIENTS UNDERGOING CARDIAC SURGERY

Levosimendan is a new inotropic agent licensed in 10 European countries (Simdax, Orion Pharma, Finland) for the treatment of acute heart failure. It has a dual mechanism of action: sensitisation of the cardiac myofilament to calcium without increasing oxygen requirements, thus enhancing cardiac contractility, and vasodilation of vascular smooth muscle. Large prospective trials that evaluated the efficacy of levosimendan in patients hospitalized for acute decompensated heart failure have concluded that this novel inotropic agent confers early additional benefit in addition to standard therapy. However, experience with levosimendan in patients with reduced cardiac output following cardiopulmonary bypass is limited. The objective of this study was to compare the short-term hemodynamic effects of levosimendan in patients with severe heart failure undergoing cardiac surgery. We reported the experience of 30 patients who underwent CABG with a poor basal EF and that received levosimendan infusion of 0.1µg-1 kg-1 min-1 for 24 hours. Levosimendan treated patients showed a better hemodynamic response, with improvement of systolic and diastolic parameters and with a significant increase of cardiac index and reduced Ees/Ea ratio near unity, in comparison with standard treatment