Abstract 4701: Levosimendan Reduces Mortality in Postoperative Low Cardiac Output Syndrome After Coronary Surgery
Introduction: The utilization of Levosimendan as a treatment for postoperative Low Output Syndrome (LOS) has been restricted to hemodynamic considerations or small series. The objective of the study was to compare the use of Levosimendan versus Dobutamine as the initial treatment in patients with postoperative LOS, considering mortality and need to add another inotropic drug, use of vasopressors or intraaortic balloon pump(IABP).
Methods: Patients developing LOS after coronary revascularization under cardiopulmonary bypass were randomized to Levosimendan(10 mcgs/kg loading dose followed by 0.1 mcg/kg/min for 24 hs) or Dobutamine(starting dose 5 mcgs/Kg/h and increasing 2.5 mcgs/kg every 15 minutes). Postoperative LOS was hemodynamically defined: low mixed venous saturation>60%, low cardiac index (lower than 2.2 L/min/m2) and a pulmonary capillary wedge pressure grather than 18 mm Hg.
Results: From 253 included patients with postoperative LOS, 127 ones received Levosimendan, while 126 patients received Dobutamine. Their general and surgical characteristics were similar. Levosimendan treated patients exhibited lower postoperative mortality: 9(7.1%) vs 20(15.9%), less requirement of another inotropic drug: 18(14.2%) vs 41(32.5%), lower use of vasopressors: 22(17.3%) vs 55(43.6%) and lower need of IABP use 4(3.1)vs18(14.2%). The P value was less than 0.05 in all cases.
Conclusions: In a randomized comparison with Dobutamine in patients with postoperative LOS, Levosimendan was effective for decreasing mortality, use of another inotropic drug and the need of vasopressors and IABP.