Levosimendan Preconditioning in Coronary Artery Bypass Grafting

Objective: To investigate whether novel pharmacological preconditioning with Levosimendan could protect the myocardial function and decrease myocardial injury in patients undergoing coronary artery bypass grafting (CABG).Methods: Forty-fife patients with stable angina who were scheduled for isolated elective CABG operations were randomized into control group (n=23) and Levosimendan group (n=22). In the Levosimendan group, 26μg/kg Levosimendan was infused intravenously within 15 min before commencing the cardiopulmonary bypass (CPB). Hemodynamic data and biochemical markers of myocardial injury were measured perioperatively.Results: There were no adverse effects related to Levosimendan infusion. Cardiac index was significantly higher in the levosimendan group (p 0.05) 30 min, 6, 12, 24 hours after CPB (3.8±0.3 vs 2.9±0.4, 4.9±0.6 vs 2.8±0.4, 3.9±0.7 vs 2.8±0.4 and 4.6±0.5 vs 3.3±0.5 respectively). There were no statistically significant differences in the other hemodynamic parameters. Although values of Troponin I and CKMB mass concentrations increased significantly in both groups after weaning from cardiopulmonary bypass, on ICU arrival, 6, 12, 24 and 48 hours after surgery these values were significantly higher in the control group. Troponin I was in the control group 1.73±0.92, 3.79±0.82, 3.29±1.12 and 2.51±1.12 vs 0.63±0.82, 1.43±0.72, 1.23±0.82 and 0.91±0.72 in the Levo-simendan group at 6, 12, 24 and 48 hours respectively. CKMB mass concentrations was in the control group 35±8, 75±33, 64±14 and 37±14 vs. 28±6, 29±5, 23±5 and 16±4 in the Levosimendan group at 6, 12, 24 and 48 hours respectively.Conclusions: Pharmacological preconditioning of the human heart with Levosimendan confers additional myocardial protection beyond that provided by the cardioplegia alone by attenuating myocardial stunning after CABG operations.