Effect Of Levosimendan On The Incidence Of Cardiac Output Dysfunction After Cardiac Surgery

Background and Objective:The development of low cardiac output syndrome in patients undergoing cardiac surgery is a catastrophic event that can lead to life-threatening complications.When low cardiac output syndrome occurs,the mortality rate in these patients can be as high as 16.9%(0.9% in the absence of LCOS).Preoperative decreased left ventricular function is considered to be a major risk factor for low cardiac output syndrome.Cardiac surgery is often associated with multiple concomitant effects,including sympathetic activation,inflammation,and hemodynamic changes,that may promote organ dysfunction.It is customary to initiate strength support at the beginning of the perioperative period to improve postoperative ventricular function.However,inotropic agents have the potential risk of increasing myocardial oxygen consumption,which may lead to cardiac ischemia,which in turn causes more burden on active myocardial cells and may lead to arrhythmias.In fact,inappropriately perioperative and postoperative use of inotropic and vasoactive agents has recently been associated with decreased postoperative survival and increased postoperative complications.The calcium sensitization agent levosimendan has been approved for the management of acute decompensated heart failure.Levosimendan is a new type of vascular active drugs,which can increased cardiac output without any increase in myocardial oxygen consumption of cells.Levosimendan also has a protective effect on multiple systems.This provides a possible solution to our perioperative cardiac management needs.We retrospectively analyzed the effect of levosimendan on the prognosis of patients with LVEF < 40% after cardiac surgery.Methods:Clinical data of 224 cardiac surgery patients with postoperative LVEF < 40%before surgery were retrospectively analyzed.According to different treatment schemes,the patients were divided into observation group and control group,with 60 cases and 164 cases respectively.The control group was treated with conventional treatment.In the observation group,levosimendan injection was given on the basis of conventional treatment after operation,starting with a dose of 6ug/kg for more than10 minutes,followed by continuous infusion at a maintenance dose of 0.2ug/kg/min for 24 hours according to the need of the disease.Then a multivariate logistic regression model with a propensity score analysis was used to limit biases and the data of 40 patients in each group were finally selected for analysis.The dates included the general information,medical history,preoperative and postoperative blood biochemical indexes,echocardiographic indexes and surgical information of the patients.RESULTS:The postoperative ICU stay time of the levosimendan group and the nonlevosimendan group were 4.13(3.74-4.53)days and 5.6(4.77-6.53)days,and the hospital stay time of the levosimendan group and the non-levosimendan group were8.49(7.69-9.08)days and 11.82(10.55-13.25)days.The difference between the two groups was statistically significant(P < 0.05).Logistics regression analysis showed that levosimendan was the only protective factor for LCOS(HR=4.33;95%CI: 1.27--14.78;P = 0.014).Conclusion:Levosimendan can improve postoperative tissue perfusion,shorten ICU stay and hospital stay,and reduce the probability of low cardiac output syndrome in patients undergoing cardiac surgery.