Levosimendan or milrinone in the type 2 diabetic patient with low ejection fraction undergoing elective coronary artery surgery

Objectives: The purpose of this study was to compare the hemodynamic profiles and the postoperative insulin requirements in 2 groups of type 2 diabetic patients with depressed myocardial function who underwent elective surgery for coronary artery disease and who received levosimendan or milrinone for postcardiopulmonary bypass low-output syndrome. Design: Randomized controlled trial. Setting: The Chest Diseases Hospital, Safat, Kuwait. Participants: Type 2 diabetic patients undergoing elective surgery for coronary artery disease. Interventions: Fourteen patients and 16 patients received levosimendan and milrinone infusions, respectively, for treatment of the low-output syndrome. Measurements and Main Results: The hemodynamic, mixed venous oxygen saturation, oxygen extraction ratios, arterial lactate concentrations, and postoperative insulin infusion rates were serially documented for the first 48 hours after the diagnosis. The cardiac index and mixed venous oxygen saturation were significantly higher in the levosimendan group. The pulmonary capillary wedge pressure, systemic vascular resistance, and oxygen extraction ratios were significantly higher in the milrinone treatment group. The insulin requirements were similar for both of the treatment groups. Conclusions: Levosimendan was more efficient than milrinone for treating the hemodynamic manifestations of the postcardiopulmonary bypass low-output syndrome. However, all the values in the milrinone treatment group were normalized. In this small population, both treatment groups had similar postoperative insulin requirements. (C) 2006 Elsevier Inc. All rights reserved.