O-77 Levosimendan versus intra-aortic balloon pump in high risk cardiac patients operated under cardiopulmonary bypass: a pilot study

Introduction. The choice of a method of haemodynamic support in patients with low ejection fraction of the left ventricle (LVEF) is the crucial moment in the management of high risk cardiac patients. The purpose of our study was to compare the efficiency of levosimendan and intra-aortic balloon pump (IABP) in high risk patients (LVEF 35%) operated under cardiopulmonary bypass (CPB). Method. From August 2009 to September 2010 40 patients with coronary artery disease, operated under CPB were randomized in two groups. In the first group levosimendan (L) infusion (0.1 mcg·kg1·min-1 for 24 hours with initial 12 mcg·kg-1 bolus) was started after anaesthesia induction. In the second group IABP was started one day before surgery. Groups were comparable in preoperative status, duration of CPB and number of graft performed. The level of troponin-I and haemodynamics (thermodilution technique) were assessed perioperatively. Blood loss, duration of ventilation, need for inotropic support, rate of complications and intensive care unit (ICU) stay were also analysed. Data are presented as mean SD, P 0.05 was considered to be significant. Results. Cardiac index (CI) in the L group was significantly higher from 5 min after CPB to 6 hours postoperatively compared to the IABP group. The increase of CI in the L group was accompanied by an increase in stroke index 30 min after CPB (32.0 8.9 vs. 28.7 4.8 ml·m-2, P 0.05) and at the end of operation (31.5 9.7 vs. 27.3 4.6 ml·m-2, P 0.05) There were no differences between groups in the duration of ventilation and rate of complications. The level of troponin-I 6 hours after operation was lower in the L group (2.74 2.0 vs. 6.7 5.9 respectively, P 0.05). Duration of ICU-stay was significantly lower in the L group. Conclusion. The use of L in high risk cardiac patients is superior to IABP in terms of maintaining stable haemodynamics during and after operation under CPB and reduction of ICU-stay. Low level of troponin-I 6 hours after the operation suggests cardioprotective properties of levosimendan.