Izvorni znanstveni članak
https://doi.org/10.22514/SV132.112017.3
Intracoronary administration of levosimendan in patients with acute coronary syndromes and decreased left ventricular ejection fraction undergoing coronary artery bypass graft surgery
MLADEN CAREV
orcid.org/0000-0003-2209-9331
; Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital Split, Split, Croatia
VJERA MARINOV
NENAD KARANOVIC
CRISTIJAN BULAT
DUBRAVKA KOCEN
MIHAJLO LOJPUR
ZDENKO COVIC
BOZENA IVANCEV
ZVONIMIR PARCINA
Sažetak
In cardiac surgery patients, intracoronary
(IC) administration of levosimendan can
provide optimal drug spread, enabling effective
manifestation of favorable drug
effects and avoiding potentially harmful
systemic hypotension. This could be
beneficial in acute coronary syndromes
(ACS) with decreased left ventricular ejection
fraction (LVEF). We present ten cases
of IC administration of levosimendan in
ACS manifested as ST segment elevation
myocardial infarction, non-ST segment elevation
myocardial infarction or unstable
angina pectoris. All patients underwent
coronary artery bypass graft (CABG) surgery,
performed as an “off-pump” or “onpump”/“
off-clamp” procedure (latter one
with the use of cardiopulmonary bypass on
the beating heart). Levosimendan was administered
as an IC bolus (125-250 μg) in
each coronary artery graft (2-3 grafts). Intravenous
(IV) levosimendan infusion continued
(0.1-0.2 μg•kg-1•min-1) after graft
placements (24-48 h), with IV infusion of
norepinephrine (0.1 mg•ml-1), if needed.
Cardiac function was assessed using LVEF
(%) (Teicholz), thermodilution cardiac index
(CI) (ml•m-2), and systemic vascular
resistance (SVR) (dynes•sec•cm-5).
Nonparametric Wilcoxon signed-ranks
test [presented as median (MED) with
interquartile range (IQR)] indicated a significant
difference between preoperative
vs. immediate postoperative CI, SVR, and
LVEF in all cases [2.2 (1.9-2.5) vs. 3.1 (2.9-
3.4) ml•m-2, 1173.0 (1062.7-1278.2) vs.
882.5 (763.5-993.0) dynes•sec•cm-5, 44.5
(36.0-46.7) vs. 53.5 (45.7-59.2) %, respectively]
(P=0.005), i.e. IC administration of
levosimendan was associated with prompt
improvement of intraoperative hemodynamics
and cardiac contractility. IC administration
of levosimendan may be a
promising alternative method for improving
decreased cardiac function in acute
cardiac ischemia, besides necessary surgical
revascularization.
Ključne riječi
levosimendan; intracoronary; acute coronary syndromes; CABG surgery
Hrčak ID:
190588
URI
Datum izdavanja:
12.12.2017.
Posjeta: 750 *