Key result
Levosimendan lowers the need for additional inotropic support ~21% vs milrinone in low-EF off-pump CABG.
Why the study?
Inotropic support influences postoperative myocardial function and outcome during off-pump CABG, prompting comparison of the hemodynamic effects of levosimendan versus milrinone in patients with compromised cardiac function.
Does levosimendan improve hemodynamic parameters and end-organ perfusion compared to milrinone in patients with compromised cardiac function undergoing off-pump CABG?
RCT (n=128)
Randomly allocated
No
Does levosimendan improve hemodynamic parameters and end-organ perfusion compared to milrinone in patients with compromised cardiac function undergoing off-pump CABG?
Levosimendan provides better hemodynamic maintenance and end-organ perfusion compared to milrinone in patients with low ejection fraction undergoing off-pump CABG.
Supports levosimendan preference over milrinone for hemodynamics in low-EF off-pump CABG; extends RCT evidence on inotrope selection in this population.
Background: Off-Pump CABG or “beating heart” surgery possess a challenge to the anesthesiologist. Main goals are provision of safe anesthesia with maximum myocardial protection and maintenance of hemodynamics with various manipulation of heart during in order to visualize and graft the coronary arteries. Anesthetic regimen and ionotropic support influences postoperative myocardial function and outcome in coronary bypass surgery patients.Objective: To compare and assess haemodynamic effects of Levosimendan and Milrinone in patient undergoing off pump coronary artery bypass grafting with compromised cardiac function (NYHA III,IV) and pre-operative, left ventricular ejection fraction (LVEF) < 45%.Subjects and Methods:Patients were randomly allocated to 2 groups (64 patients in each group). Levosimendan Group (Group A) received infusion of Inj. Levosimendan 0.1µg/kg/min after loading dose of 12μg/kg over 10 mins. While Milrinone Group (Group B) received infusion of inj. Milrinone 0.5µg/kg/min after loading dose of 50 μg/kg over 10 mins. HR, MAP, CVP, CI, SVRI, lactate levels were monitored at baseline, after induction, after sternotomy, at 30mins ,thereafter 6, 12, and 24 hours using Flo-Trac sensor (Edwards Life sciences).Results:Heart Rate, CI was significantly higher in Levosimendan group while MAP, SVRI and lactate levels were lower in Levosimendan group as compared to Milrinone group. Need of other inotropic support is more in Milrinone group.Conclusion:Levosimendan maintained the haemodynamic parameters better as compared to Milrinone in off pump CABG patients with low preoperative ejection fraction and also better end organ perfusion represented by lower lactate levels.
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Vyas et al. (2020) conducted an RCT in Compromised cardiac function (NYHA III, IV) and LVEF < 45% undergoing off-pump CABG (n=128). Levosimendan vs. Milrinone (0.5µg/kg/min infusion after loading dose of 50 μg/kg over 10 mins) was evaluated on Need for additional inotropic support (p=<0.05). Levosimendan maintained better hemodynamic parameters and resulted in a significantly lower need for additional inotropic support (51.5% vs 65.6%) compared to milrinone in patients undergoing off-pump CABG with low ejection fraction.
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