Please select the eligibility criteria that correspond to the clinical trial below.
Title: Effects of Levosimendan Pretreatment in Patients With Low Ejection Fraction (40 % or Less) Undergoing CABG: a Randomised, Double Blind, Multicenter Trial
Brief Summary: The investigators want to test the hypothesis that an infusion of levosimendan started prior to CABG surgery can reduce incidence and severity of low cardiac output syndrome in patients with poor LV function (EF 40% or less).


Options:
A: Inclusion Criteria:

* Documented LVEF ≤35% measured by ventriculogram, echocardiogram (ECHO), nuclear scan, or MRI within 60 days before surgery.
* Scheduled or urgent 1) CABG surgery, 2)CABG with aortic valve surgery, 3) CABG with mitral valve surgery, or 4) mitral valve surgery with or without other valves
* Surgery will employ CPB pump
* Signed (by the subjects or their legally acceptable representatives) informed consent document indicating that they understand the purpose of and procedures required for the study and are willing to participate in the study

Exclusion Criteria:

* Restrictive or obstructive cardiomyopathy, constrictive pericarditis, restrictive pericarditis, pericardial tamponade, or other conditions in which cardiac output is dependent on venous return.
* Evidence of systemic bacterial, systemic fungal, or viral infection within 72 hours before surgery.
* Dialysis at randomization (either hemodialysis, peritoneal dialysis, continuous venovenous hemofiltration, or ultrafiltration).
* Estimated glomerular filtration rate (eGFR) \<30 mL/min/1.73m2.
* Weight ≥ 170 kg.
* Patients whose SBP cannot be managed to ensure SBP \> 90 mmHg at initiation of study drug.
* Heart rate ≥ 120 bpm, persistent for at least 10 minutes screening and unresponsive to treatment.
* Hemoglobin \< 80 g/L.
* Serum potassium \< 3.5 mmol/L and \> 5.5 mmol/L at baseline.
* A history of Torsades de Pointes.
* Mechanical assist device (IABP, LVAD, ECMO) in the patient at the start of surgery or pre-planned to be inserted during surgery before coming off CPB.
* Patients with aortal femoral occlusive disease that would prohibit use of IABP unless VAD or ECMO not available.
* Liver dysfunction Child Pugh Class B or C
* Patients having severely compromised immune function
* Pregnant, suspected to be pregnant, or breast-feeding.
* Received an experimental drug or used an experimental medical device in previous 30 days.
* Known allergic reaction or sensitivity to Levosimendan or excipients.
* Received commercial Levosimendan within 30 days before the planned start of study drug.
* Employees of the investigator or study center, with direct involvement in the proposed study or other studies under the direction of that investigator or study center, as well as family members of the employees or the investigator.
B: Inclusion Criteria:

* age ≥18 years
* intention to perform first-time multi-vessel CABG

Exclusion Criteria:

* unstable angina
* valvular disease
* diabetes mellitus treated with sulphonylurea drugs
* renal failure
* severe hepatic disease
* severe chronic obstructive pulmonary disease
* a history of prior CABG surgery
* recent myocardial infarction (MI) within the previous month
C: Inclusion Criteria:

* Written informed consent
* Age \> 18 years
* Perioperative myocardial dysfunction

Exclusion Criteria:

* Previous unusual response to levosimendan or soluvit or any of their components
* Inclusion in other randomised controlled studies in the previous 30 days
* Levosimendan administration in the previous 30 days
* Parkinson's disease
* Emergency operation
* Kidney or liver transplant
* Liver cirrhosis (Child B or C)
* Decision to use ECMO (ECMO already started or planned)
* Do not resuscitate patient
D: Inclusion Criteria:

* 18 Years and older
* scheduled for CABG with CPB
* with or without asociated cardiac repair
* ejection fraction less than 40%
* signed informed consent

Exclusion Criteria:

* preoperative renal failure (creatinine clearance less than 30 ml/min)
* liver failure (prothrombine time less than 50% in the absence of vitamin K antagonist)
* cardiac surgery without CABG
* pregnancy
* emergency surgery
* known allergy to levosimendan
* severe hypotension prior to surgery
* severe tachycardia
* prior history of torsade de pointe
* dynamic obstruction od left ventricular outflow tract
* lack of signed informed consent.

Answer: D