Perioperative Use of Levosimendan in Patients with Impaired Right Ventricular Function Undergoing Cardiac Surgery with Cardiopulmonary Bypass A Randomized Controlled Study

Background: The purpose of this study is to investigate the impact of levosimendan on right ventricular (RV) function in patients with reduced RV function after open heart surgery with cardiopulmonary bypass (CBP). Methods: The study included 120 adult patients submitted to cardiac surgery. All patients had impaired right ventricular function. In the levosimendan group (n=60), patients were admitted to ICU preoperatively and levosimendan infusion started after insertion of an arterial line 12 hours before surgery and was continued in operating room and then in the ICU (total infusion time of 24 hours). In the standard treatment group, patients (n=60) were managed with standard care according to our institutional protocol. Results: Intraoperatively, patients in the levosimendan group had significantly higher TAPSE as compared to the control group (13.7 ± 0.99 versus 11.9 ± 1.3 mm, p<0.001). The advantage of levosimendan group continued at postoperative days 1 , 3 and 7. In addition, it was shown that patients in the levosimendan group had significantly lower vasoactive inotrope score (VIS) at 12, 24 and 48 hours when compared to control groups. Furthermore, levosimendan group experienced significantly lower rate of rapid AF, shorter MV duration, shorter ICU and hospital stay.Conclusion: Prophylactic use of levosimendan improves RV function and overall outcomes in patients undergoing open-heart surgery.