[The calcium sensitizer levosimendan gives superior results to dobutamine in postoperative low cardiac output syndrome].

Introduction And Objectives: The use of levosimendan to treat postoperative low cardiac output syndrome (LCOS) has been studied in only small patient series and in randomized trials focusing on hemodynamic variables. The objective of the present study was to assess the effectiveness of levosimendan, compared with dobutamine, as a treatment for postoperative LCOS.

Methods: Patients with LCOS were randomly assigned to receive either levosimendan (loading dose, 10 microg/kg, followed by 0.1 microg/kg per min for 24 h) or dobutamine (starting dose, 5 microg/kg per min). Hemodynamic and clinical parameters (including postoperative mortality and major complications), the need for the coadministration of another drug (such as an inotrope or a vasopressor) or for balloon counterpulsation, and length of stay in intensive care were all monitored.

Results: The study included 137 patients: 69 received levosimendan, while 68 were treated with dobutamine. Although both agents improved hemodynamic parameters, the effect of levosimendan was greater and occurred earlier than that of dobutamine. In addition, levosimendan use resulted in lower postoperative mortality (8.7% vs. 25%; P< .05), a lower incidence of major postoperative complications, and less need for an additional inotropic drug (8.7% vs. 36.8%; P< .05), a vasopressor (11.6% vs. 30.9%; P< .05), or balloon counterpulsation (2.9% vs. 14.7%; P<0.05). The length of stay in intensive care was also less (66 vs. 158 h; P< .05).

Conclusions: In this randomized study, levosimendan proved more effective than dobutamine. Postoperative morbidity and mortality were lower, fewer patients required either an additional inotropic drug, a vasopressor or intra-aortic balloon counterpulsation, and the length of stay in intensive care was shorter.