Hemodynamic effects of levosimendan in low cardiac output syndrome post-CABG refractory to standard inotropic therapy.

backgroundLow cardiac output syndrome (LCOS) following coronary artery bypass grafting (CABG) remains a major cause of morbidity and mortality. Standard inotropes frequently provide only marginal hemodynamic benefit and are associated with increased myocardial oxygen consumption and arrhythmogenic risk. Levosimendan, a calcium sensitizer with inodilatory properties, may offer more favorable hemodynamics without these adverse effects.

methodsIn this retrospective study, we evaluated 41 patients with LCOS post-CABG who failed to respond to standard catecholamines, defined by < 20% improvement in cardiac output. Levosimendan (0.1-0.2 µg/kg/min over 24 h) was administered. Hemodynamic parameters including cardiac index (CI), systemic vascular resistance (SVR), mean arterial pressure (MAP), cardiac power index (CPi), and serum lactate were recorded at baseline and at 3, 24, 48, 72, and 96 h post-infusion.

resultsLevosimendan significantly increased CI from 2.08 ± 0.08 to 2.89 ± 0.19 L/min/m

conclusionThis retrospective single-center case series suggests that levosimendan may be associated with hemodynamic improvement in patients with LCOS after CABG who are unresponsive to standard therapy. However, due to the absence of a control group and the retrospective design, these findings should be considered exploratory and hypothesis-generating.