EFFECT OF LEVOSEMINDAN ON OUTCOME OF CORONARY ARTERY BYPASS GRAFTING SURGERY IN PATIENT WITH IMPAIRED LEFT VENTRICULAR SYSTOLIC FUNCTION

Abstract

Background : Coronary artery bypass grafting (CABG) is often complicated by hemodynamic instability, especially in cases with decreased left ventricular ejection fraction (LVEF). Levosimendan as an inotropic agent can be used in those patients. Objective : The aim was to assess morbidity and mortality rates up to 6 months following CABG surgery in patients with LVEF equals 35%, who were given levosimendan. Patients and methods : A total of 40 patients with preoperative LVEF less than or equal to 35% who underwent elective CABG were retrospectively analyzed between March 2020 and April 2022 at Al-Azhar University Hospitals. Levosi-mendan was u continuously given as a bolus-free infusion at a rate of 0.05 e 0.2 m g/kg/min before surgery. Hemodynamic and outcome parameters were registered and statistically analyzed. Results : A signi fi cant improvement was recorded in ejection fraction percentage from 32.8 to 35.9% and then 39.4% after 1 week and 6 months, respectively; it was associated with signi fi cant increase in cardiac output from 5.22 to 6.3 l/ min and 6.1 l/min after 1 week and 6 months, respectively. Mean arterial pressure was also increased from 63.44 to 80.4 mm Hg and 84.6 mm Hg after 1 week and 6 months, respectively. Overall, 80% of patients showed no complications, whereas 5% of them had low cardiac output syndrome, 5% needed intra-aortic balloon pump (IABP), 5% rapid atrial fi brillation, and 5% needed reoperation due to bleeding. On the contrary, postoperative (later) complications included the following: severe sternal wound infection in two cases (5%) and chronic atrial fi brillation in one case (2.5%). The overall mortality rate was 10%. Conclusion : Levosimendan has a bene fi cial effect in improving hemodynamic state. In addition, it aids the reduction of hospital and ICU stays, along with the ability to reduce the incidence of low cardiac output syndrome and mortality rate.