Preoperative levosimendan in heart failure patients undergoing noncardiac surgery

Background: Heart failure (HF) is a major cause of perioperative morbidity and mortality in noncardiac surgery. Preoperative optimisation of these patients is, thus, of utmost importance. Levosimendan seems promising for patients undergoing cardiac surgery; however, its safety and efficacy in HF patients undergoing noncardiac surgery have not been evaluated. Objective: To evaluate the effects of prophylactic preoperative levosimendan administration on left ventricular function in HF patients undergoing noncardiac surgery. Methods: HF patients with ejection fraction <30% undergoing elective noncardiac surgery in 2005 were included in this prospective study. Patients were admitted to our surgical intensive care unit one day preoperatively. Under continuous haemodynamic monitoring, the treatment protocol consisted of an initial loading dose (24 mu g/kg) for ten minutes followed by a continuous 24-hour infusion (0.1 mu g/kg/min) at the end of which patients underwent surgery. Echocardiography was performed before infusion (day o) and on the 7th postinfusion day (day 7). Measurements included left ventricular ejection fraction (LVEF), velocity time integral (VTI), pre-ejection period (PEP), ejection time (ET), maximum (P-max) and minimum (P-min) transvalvular aortic pressure gradient, and maximum (V-max) and minimum (V-min) aortic velocity. Results: Twelve consecutive patients were enrolled. Levosimendan resulted in a significant increase in LVEF, VTI, P-max, P-min, V-max, and V-min. (p< 0.01) and, moreover, a significant reduction in PEP, ET, and PEP/ET (P=0.04) on day 7 compared with day o values. No adverse reactions, complications or mortality occurred during 30-day follow-up. Conclusion: Prophylactic preoperative levosimendan treatment may be safe and efficient for perioperative optimisation of heart failure patients undergoing noncardiac surgery.