The possibilities of using levosimendan in medical preparation to Coronary Artery Bypass Grafting in coronary artery disease patients with low left ventricular ejection fraction


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Abstract

Aim: to work out an approach of preoperative drug preparation for CAD patients with low LVEF and varying degrees of compensation for CHF, to study the possibility of using levosimendan (L) in this preparation. Materials and methods. We studied 82 patients with severe angina pectoris, multivascular coronary disease, extensive postinfarction zone, LVEF ≤35%, chronic heart failure and proven viable myocardium, which performed CABG. All patients received long - term standard CHF therapy before surgery: loop diuretic, ACE/ARA, beta - blocker, aldosterone antagonist. In the first, retrospective part of the study (39 pts), it was determined which factors could be associated with perioperative AHF. In the second, prospective part (43 pts), the course of the operation and the early postoperative period in patients with compensated and uncompensated heart failure were compared; uncompensated pts received L 2 days before surgery in addition to standard therapy. The third, retro - prospective part of the study (37 pts) was the assessment of operation outcome in patients only with uncompensated pre - operative CHF, but with different preoperative drug preparation. Results. Statistically significant direct influence on the perioperative AHF development was provided by the combined clinical sign - venous pulmonary congestion+orthopnea (p<0.01). Patients with this sign presence, i.e. with uncompensated CHF, were infused with L before surgery; in this case the operation outcomes and the early postoperative period were similar to those in patients initially compensated; the only significantly different parameter was the Vasoactive Inotropic Score (VIS) at the end of the surgery (p=0.03). The effect of L was confirmed in the analysis of patients only with uncompensated CHF: those receiving L had significantly (p<0.05) lower VIS, inotropic support duration, time spent in ICU and hospital stay. Conclusion. For CABG candidates with low LVEF and uncompensated CHF preoperative use of levosimendan is advisable; it improves the operation outcome and the course of the early postoperative period.

About the authors

V P Gazizova

A.L. Myasnikov Institute of Cardiology of National Medical Research Center of Cardiology

Email: viktoriia.barkar@mail.ru
аспирант отд. сердечно-сосудистой хирургии НИИ клинической кардиологии им. А.Л. Мясникова ФГБУ «НМИЦ кардиологии» Минздрава Россииu; ORCID: 0000-0002-2904-2883 Moscow, Russia

E E Vlasova

A.L. Myasnikov Institute of Cardiology of National Medical Research Center of Cardiology

к.м.н., с.н.с. отд. сердечно-сосудистой хирургии НИИ клинической кардиологии им. А.Л. Мясникова ФГБУ «НМИЦ кардиологии» Минздрава России, ORCID: 0000-0003-2925-244X Moscow, Russia

E V Dzybinskaya

A.L. Myasnikov Institute of Cardiology of National Medical Research Center of Cardiology

д.м.н., с.н.с. отд. анестезиологии и защиты миокарда НИИ клинической кардиологии им. А.Л. Мясникова ФГБУ «НМИЦ кардиологии» Минздрава России, ORCID: 0000-0002-1849-442х Moscow, Russia

V V Gramovich

A.L. Myasnikov Institute of Cardiology of National Medical Research Center of Cardiology

к.м.н., н.с. отд. легочной гипертензии и заболеваний сердца НИИ клинической кардиологии им. А.Л. Мясникова ФГБУ «НМИЦ кардиологии» Минздрава России, ORCID: 0000-0003-3292-0912 Moscow, Russia

O V Stukalova

A.L. Myasnikov Institute of Cardiology of National Medical Research Center of Cardiology

к.м.н., с.н.с. лаб. МР-томографии НИИ клинической кардиологии им. А.Л. Мясникова ФГБУ «НМИЦ кардиологии» Минздрава России, ORCID: 0000-0001-8377-2388 Moscow, Russia

A A Shiryaev

A.L. Myasnikov Institute of Cardiology of National Medical Research Center of Cardiology

д.м.н., проф., руководитель лаб. микрохирургии сердца и сосудов отд. сердечно-сосудистой хирургии НИИ клинической кардиологии им. А.Л. Мясникова ФГБУ «НМИЦ кардиологии» Минздрава России, ORCID: 0000-0002-2105-8258 Moscow, Russia

R S Akchurin

A.L. Myasnikov Institute of Cardiology of National Medical Research Center of Cardiology

акад. РАН, проф., зам. ген. директора по хирургии ФГБУ «НМИЦ кардиологии» Минздрава России, руководитель отд. сердечно-сосудистой хирургии НИИ клинической кардиологии им. А.Л. Мясникова ФГБУ «НМИЦ кардиологии» Минздрава России, ORCID: 0000-0002-2105-8258 Moscow, Russia

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