LEVOSIMENDAN IN PREOPERATION THERAPY FOR CARDIOSURGERY IN PATIENTS WITH CHRONIC HEART FAILURE

Aim. To evaluate the efficacy of action of the calcium sensitizer levosimendan (LS) in patients with various grade of heart failure (HF) severity before cardiosurgery.

Material and methods. LS was applied as a part of HF treatment while preparing patients for surgery in 2-4 days. Performed dose was 0,025 — 0,1 µg/kg/min. The drug was not administered  in bolus. Preoperation group of participants  included 108 patients (62% — men, 38% — women, aged 20 — 72 years (53±13)) with CHF III-IV  FC by NYHA,  with ejection  fraction  of the  left ventricle  (LVEF)  about  in average  27±8%.Mean  level of natriuretic  B-type  peptide  was  1129  (Me 854, Q₂₅ 396, Q₇₅ 1419) pg/mL. Main etiology of chronic HF in participants  was dilation  cardiomyopathy:  noncoronary  cardiomyopathy  in 30 patients  (27,7%), ischemic cardiomyopathy  (ischemic  heart  disease, postinfarction  cardiosclerosis) in 72 patients (66,7%) and acquired valve defects  in 6 patients (5,6%). For assessment of efficacy of the drug in various grade  of HF severity, patients  were selected to subgroups according  to the level of LVEF decrease (less 20%, 21-30%, 31-40%, more 40%), and pulmonary artery pressure (PAWP) (less 40 mmHg, 40-70 mmHg, more 70 mmHg).

Results. Infusion of the drug led to statistically significant increase of LVEF comparing to the baseline (57%), decrease of PAWP (64%) and BNP concentration in 77% cases. Conclusion. The LS is an effective medication which can be applied with the aims to prepare HF patients to cardiosurgical operations. Most sensitive parameters of LS efficacy are PAWP, LVEF and BNP concentration. The highest efficacy of the drug was observed  in subgroup  with EF ≤40%, PAWP ≥40 mmHg and BNP ≥600 pg/mL. LS, applied in HF patients  before  cardiosurgery, can  be  used  for assessment of reserves  of myocardial capacity.

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