The Effect of Pre-Operative Prophylactic Levosimendan “A Calcium Sensitizer” for on Pump Coronary Artery Bypass Grafting in Patients with Low Ejection Fraction

Background: On pump CABG is associated with more complete revascularization as compared to OPCAB but due to the use of CPB Machine it is associated with severe Inflammatory Response eventually leading to adverse effects, especially in patients with low ejection fraction & appropriate selection of Inotropes plays a very important role in perioperative management of these patients.

Aim and Objective: To study the effects of Levosimendan when it is used prophylactically in perioperative period in patients with low ejection fraction undergoing On Pump CABG.

Materials and Methods: After Institutional ethics Committee approval and obtaining written informed consent, 60 patients undergoing elective On Pump CABG were randomly divided into two groups (n=30 each). Group A patients were started on Injection Levosimendan Infusion @ 0.1 µg/kg/min in operation theatre & hemodynamic parameters such as Heart Rate, Invasive Blood Pressure, Pulmonary Capillary Wedge Pressure (PCWP), Cardiac Index (CI), Pulse Oximetry, Nasopharyngeal Temperature Capnography, Urine Output & Arterial Blood Gas including Serum Lactate were monitored at To (baseline), T1 (15 mins after OM & PDA anastomoses), T2 (at end of surgery), T3 ( 6 hrs after surgery), T4 ( 12 hrs after surgery), & T5 ( 24 hrs after surgery).

Results: In group A CI was significantly higher & PCWP was significantly lower compared to group B. In group B there was significantly reduction in MAP at T1& there was also a significantly number of patients who developed Acute Kidney Injury compared to group A. Group A patients had lower number of POAF, lesser need for IABP, compared to group B.

Conclusion: Inpatients with low ejection fraction who are undergoing On Pump CABG, Prophylactic preoperative Levosimendan is associated with decreased hemodynamic perturbations&are associated with favorable clinical outcome.