On the role of levosimendan in restoring the function of hibernated myocardium in patients with coronary artery disease with reduced cardiac contractility during CABG operations
Authors:   St. George thoracic and cardiovascular surgery clinic Pirogov National Medical and Surgical Center, Moscow, Shevchenko Yu.L. , Stepanova A.S. ,   St. George thoracic and cardiovascular surgery clinic Pirogov National Medical and Surgical Center, Moscow, Gorokhovatsky Yu.I. ,   St. George thoracic and cardiovascular surgery clinic Pirogov National Medical and Surgical Center, Moscow, Vakhromeeva M.N. ,   St. George thoracic and cardiovascular surgery clinic Pirogov National Medical and Surgical Center, Moscow
Published: November 2024

Purpose of the study: to study the effect of perioperative use of levosimendan on the restoration of viable myocardium in patients with coronary artery disease with a significantly reduced left ventricular ejection fraction during myocardial revascularization. An open, prospective, randomized study was conducted, including 98 patients. The patients were divided into two groups. In group I (n = 55), levosimendan infusion was used perioperatively. Administration of the drug (loading dose of 12 mcg/kg/min for 10 minutes) began after induction of anesthesia and continued infusion at all stages of the operation and in the immediate postoperative period. The total time of drug administration was 24 hours. In group II (n = 43), standard drugs were used to correct the circulatory system. It was found that the inclusion of levosimendan in a comprehensive program of cardioprotection caused a more rapid recovery of hibernated myocardium. This assumption is based on the fact that in patients of group I, the use of levosimendan led to a decrease in the volume of hibernation after surgery, in comparison with the preoperative level, by 42%. At the same time, in group II of patients operated on without the use of the drug, the percentage reduction in the volume of viable myocardium was 13%. In addition, a clear dependence of the state of the pumping function of the heart on the hemodynamic effects of levosimendan was discovered. Thus, in patients of group I, an increase in cardiac index was detected from 2.23±0.49 to 2.96±0.52 l./min./m2 (p<0.05), an increase in minute blood volume from 4.51± 0.99 to 6.04±1.1 l./min. (p<0.05), decrease in pulmonary valve wedge pressure from 13.3±4.6 to 9.8±3.07 mmHg. (p<0.05). In addition, levosimendan had a clear anti-ischemic effect. This was expressed in a lower concentration of troponin I in patients of group I, in comparison with patients of group II, at the stage of the study after surgery (I group – 2.78 ± 2.31 ng./ml., II group – 3.45 ±4.9 ng./ml., p<0.05). It should be noted that, simultaneously with a decrease in the volume of hibernated myocardium, in patients of group I there was an increase in the ejection fraction of the left ventricle from 40% to 49% (p<0.05). The data presented indicate an improvement in the functional state of the myocardium against the background of the prevention of ischemic and reperfusion disorders with levosimendan. It was noted that the preoperative volume of hibernated myocardium and the usefulness of reperfusion could have an additional influence on the implementation of the protective effects of levosimendan. Thus, there is some reason to believe that myocardial conditioning with levosimendan improved contractility in the reperfusion zones of hibernated myocardium during coronary artery bypass surgery in patients with ischemic left ventricular dysfunction.