Résumé
Background: Many adult patients require temporary inotropic support after cardiac surgery. However, cardiac displacement and manipulation during OPCAB may cause some hemodynamic alterations. So, prophylactic usage of inotropic agents would be mandatory even in patients with normal left ventricular function. The aim of our study is to compare between levosimendan and ephedrine-calcium as inotropic agents during OPCAB in patients with normal left ventricular function
Methods: 24 patients with normal ventricular function included in this randomized controlled trial, were divided into 2 groups: Group A [n=12] received ephedrine-calcium boluses immediately prior to revascularization. Group B [n=12], received 12ug/kg of levosimendan over a period of 15 minutes, immediately after induction of anesthesia. The heart rate, cardiac index, stroke volume index, and left ventricular ejection fraction were measured before and 10 and 60 minutes after the drugs administration as well as 2 hours postoperatively
Results: Heart rate was significantly higher in the calcium-ephedrine group than in the levosimendan one after 10 and 60 minutes from the beginning of revascularization [P<0.05]. Compared with ephedrine-calcium group, cardiac index was significantly higher 10, 60 minutes and 2 hours postoperative [p< 0.05] after administration of levosimendan. Stroke volume index was significantly higher 10 minutes after levosimendan administration [p< 0.05]. Left ventricular ejection fraction increased significantly after 60 minutes, and 2 hours postoperative in the levosimendan group [P<0.05]
Conclusion: Levosimendan in a dose of 12 ug/kg over a period of 15 minutes enhances the left ventricular performance during off-pump coronary artery bypass grafting in patients with normal preoperative left ventricular function, better than calcium-ephedrine with neutral effect on myocardial energy