Prophylactic Preoperative Levosimendan Administration in Heart Failure Patients Undergoing Elective Non-Cardiac Surgery: A Preliminary Report

Introduction: Preoperative optimization of cardiac failure (CF) patients undergoing non-cardiac surgery is of utmost importance. Levosimendan is a promising adjunct in our therapeutic repertoire for the treatment of CF; however, it has not been evaluated in CF patients undergoing non-cardiac surgery. Our objective was to evaluate the safety and efficacy of prophylactic preoperative levosimendan administration in these patients. Methods: CF patients with ejection fraction <35% undergoing elective non-cardiac (abdominal) surgery during a 6-month-period were included in this prospective study. All patients, admitted to the Surgical Intensive Care Unit (SICU) one day preoperatively for levosimendan administration, received a bolus infusion (2.4 mu g/kg) for 10 min followed by a 24-hour continuous infusion (0.1 mu g/kg/min) at the end of which they were operated. Patients were under continuous hemodynamic monitoring in the SICU during levosimendan infusion and for 24 h post-infusion. Hemodynamic parameters, including heart rate, arterial pressure and pulmonary artery catheter data, were recorded before treatment, 10 min after drug initiation, and at 3-hour intervals to 24 h post-infusion. Echocardiography was performed before infusion and on the 7th post-infusion day. Results: Nine patients were enrolled. Cardiac index (0-48 h, 95% CI: -2.790-0.432, p<0.001) and stroke volume index (0-48 h, 95% CI: -32.53-0.91, p=0.01) increased significantly at 24 h after drug initiation and remained increased for 24 h post-infusion. Systemic vascular resistance index decreased at 10 min and remained reduced during the whole observation period (0-48 h, 95% CI: 875.64-2378.14, p<0.001). Ejection fraction was significantly increased on the 7th post-infusion day (32.65 +/- 7.32 vs. 20.89 +/- 6.24, p<0.05). No adverse reactions, complications or deaths occurred during 30 days' follow up. Conclusion: Prophylactic preoperative levosimendan treatment may be safe and efficient for the perioperative optimization of heart failure patients undergoing non-cardiac surgery.