Evaluation of the preoperative levosimendan use effectiveness in patients with left ventricular ejection fraction less than 30% during surgical remodeling of the left ventricle

• Vladlen V. Bazylev
• Klara T. Shcheglova
• Savelii E. Shcheglov
• Anton I. Magilevets

Abstract

Aim – to evaluate the preoperative use of levosimendan infusion effectiveness in patients with left ventricular ejection fraction less than 30% during its surgical remodeling; identify mortality predictors in this group of patients.

Material and methods. A retrospective comparative study included 219 cardiac surgical patients with left ventricular ejection fraction less than <30% who underwent left ventricular remodeling surgery between January 2017 and June 2022. In all cases, open cardiac surgery with cardiopulmonary bypass was performed from January 2017 to June 2022. Patients were divided into two groups: in the first, main (n=109), preoperative infusion of levosimendan was performed, in the second, control (n=110), levosimendan was not administered.

Results. The duration of the inotropes, vasopressors usage and the inotropic number, the mechanical ventilation time, the need for renal replacement therapy, extracorporeal circulation and the use of mechanical circulatory support, reoperation, as well as the length of stay in the intensive care unit and in the hospital did not differ between patients of the two groups. The overall mortality was 2.2% (2.7 and 1.8% in the main and control groups respectively) and did not differ statistically significantly between the groups (p=0.12).

Mortality predictors in patients with left ventricular failure are ejection fraction before surgery less than 25% (p=0.01), effective stroke volume index less than 23 ml/m² (p=0.012), lactate concentration more than 5 mmol/l after surgery (p=0.01). The use of levosimendan had no effect on the mortality rate (p=0.63).

Conclusion. Preoperative use of levosimendan does not affect the clinical course of the postoperative period and mortality.

Keywords:levosimendan; cardiac surgery; left ventricular dysfunction

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