Levosimendan facilitates weaning from cardiopulmonary bypass in patients undergoing coronary artery bypass grafting with impaired left ventricular function

Ann Thorac Surg. 2009 Feb;87(2):448-54. doi: 10.1016/j.athoracsur.2008.10.029.


Background: Levosimendan is a compound with vasodilatory and inotropic properties. Experimental data suggest effective reversal of stunning and cardioprotective properties.

Methods: This prospective, randomized, placebo-controlled, double-blind study included 60 patients with 3-vessel coronary disease and left ventricular ejection fraction (LVEF) of less than 0.50. Levosimendan administration (12 microg/kg bolus, followed by an infusion of 0.2 microg/kg/min) was started immediately after induction anesthesia. Predefined strict hemodynamic criteria were used to assess the success of weaning. If weaning was not successful, CPB was reinstituted and an epinephrine infusion was started. If the second weaning attempt failed, intraaortic balloon pumping (IABP) was instituted.

Results: The groups had comparable demographics. The mean (standard deviation) preoperative LVEF was 0.36 (0.8) in both groups. The baseline cardiac index was 1.8 (0.3) L/min/m(2) in the levosimendan group and 1.9 (0.4) L/min/m(2) in the placebo group. The mean duration of CPB to primary weaning attempt was 104 (25) minutes in the levosimendan and 109 (22) minutes in the placebo group. Primary weaning was successful in 22 patients (73%) in the levosimendan group and in 10 (33%) in the placebo group (p = 0.002). The odds ratio for failure in primary weaning was 0.182 (95% confidence interval, 0.060 to 0.552). Four patients in the placebo group failed the second weaning and underwent IABP compared with none in the levosimendan group (p = 0.112).

Conclusions: Levosimendan significantly enhanced primary weaning from CPB compared with placebo in patients undergoing 3-vessel on-pump coronary artery bypass grafting. The need for additional inotropic or mechanical therapy was decreased.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Analysis of Variance
  • Cardiopulmonary Bypass / methods*
  • Confidence Intervals
  • Coronary Angiography
  • Coronary Artery Bypass / methods*
  • Coronary Artery Bypass / mortality
  • Coronary Stenosis / diagnostic imaging
  • Coronary Stenosis / mortality
  • Coronary Stenosis / surgery*
  • Double-Blind Method
  • Education, Medical, Continuing
  • Female
  • Hemodynamics / drug effects
  • Humans
  • Hydrazones / administration & dosage*
  • Infusions, Intravenous
  • Male
  • Middle Aged
  • Monitoring, Intraoperative / methods
  • Postoperative Complications / mortality
  • Preoperative Care / methods
  • Prospective Studies
  • Pyridazines / administration & dosage*
  • Reference Values
  • Risk Assessment
  • Severity of Illness Index
  • Simendan
  • Stroke Volume / drug effects
  • Survival Analysis
  • Treatment Outcome
  • Ventricular Dysfunction, Left / diagnosis*


  • Hydrazones
  • Pyridazines
  • Simendan