Levosimendan versus intra-aortic balloon pump in high-risk cardiac surgery patients

Objective: Patients with severe left ventricular dysfunction receive inotropic and mechanical circulatory support with an intra-aortic balloon pump (IABP) during the perioperative phase of cardiac surgery. The authors performed the first comparison of levosimendan versus an IABP in patients with poor left ventricular function undergoing cardiac surgery. Design: A case-matched study. Setting: A teaching hospital. Participants: Twenty-two heart failure patients scheduled to undergo elective coronary artery bypass graft surgery with or without concomitant mitral surgery. Interventions: Eleven patients received levosimendan at a dose of 0.1 μg/kg/min for 24 hours without an initial bolus. The control group, also 11 patients, received a preoperative IABP. The intensive care unit stay was the major endpoint of this study. Biochemical, hemodynamic, and echocardiographic data were collected together with the time on mechanical ventilation and 30-day mortality. Measurements and Main Results: The length of intensive care unit stay was reduced in patients receiving levosimendan (median, 2.5; range, 1-3 days) compared with those receiving an IABP (median, 5; range, 3-6 days; p = 0.01). No deaths occurred in the levosimendan group; 1 patient died in the intra-aortic balloon pump group. Conclusions: Patients receiving levosimendan had a shorter duration of intensive care stay than peers who received a preoperative IABP. The findings of this pilot study should be investigated further in a large randomized controlled study.