The effects of levosimendan on renal functions in open-heart surgery patients with a low ejection fraction
Süleyman Yazıcı1*, Mehmet N. Karabulut1, Ayşe Baysal2, Rahmi Zeybek3
1BAŞAKŞEHIR ÇAM VE SAKURA CITY HOSPITAL, DEPARTMENT OF CARDIOVASCULAR SURGERY, İSTANBUL, TURKEY
2PENDIK BAYPARK HOSPITAL, DEPARTMENT OF ANESTHESIA AND REANIMATION, İSTANBUL, TURKEY
3PENDIK BÖLGE HOSPITAL, DEPARTMENT OF CARDIOVASCULAR SURGERY, İSTANBUL, TURKEY
Purpose. This study investigated the effects of levosimendan on renal functions in patients with a preoperative low ejection fraction undergoing open-heart surgery and cardiopulmonary bypass (CPB). Materials and Methods. The study retrospectively evaluated 64 patients with a diagnosis of mitral valve insufficiency and left ventricular dysfunction undergoing open-heart surgery with CPB. Patients were divided depending on the preoperative blood creatinine level less (Group 1) or more than 1.2 mg/dL (Group 2). A bolus dose of levosimendan was administered through the aortic arch at the end of the CPB, preceding an infusion of levosimendan intravenously in all patients. Demographic data, preoperative and 48-hour postoperative echocardiographic studies were done. The blood urea and creatinine levels were collected preoperatively and on postoperative days 1, 3, and 10. The use of inotropic support, intra-aortic balloon pump, and complications were recorded. Results. The demographic data were similar between groups (p>0.05). Preoperative serum creatinine levels were higher in Group 1 in comparison to Group 2 (p=0.01, p<0.001, respectively). The aortic cross-clamp and cardiopulmonary bypass times were similar between groups (p>0.05). Preoperative serum creatinine levels were higher in Group 1 in comparison to Group 2 (p<0.001). On postoperative day 1, serum creatinine levels of Group 1 were significantly lower than Group 2 (p<0.001). On postoperative days 3 and 10, no differences were observed regarding serum creatinine levels between groups (p>0.05). Complications were similar between groups (p>0.05). Conclusions. In patients with low ejection fraction undergoing open-heart surgery, the use of levosimendan intraoperatively and 24 hours postoperatively prevents deterioration of renal functions in patients with or without preoperative disturbance in serum creatinine level.