Preconditioning effects of levosimendan in coronary artery bypass grafting; a pilot study.

Background. The calcium sensitizer levosimendan protects against myocardial ischaemia and reperfusion injury in animal models. Methods. The present pilot study investigated whether a short infusion before coronary artery bypass grafting (CABG) would protect the myocardium and improve postoperative haemodynamics. Twenty-four patients with stable angina undergoing elective CABG surgery were randomized to receive either placebo or levosimendan (24 mg kg1) infused i.v. over a 10 min period just before placing the patient on cardiopulmonary bypass. Results. Perioperative haemodynamic variables, concentrations of cardiac troponin I over the 48 h postoperative period, and clinical outcomes were assessed. There were no adverse effects related to levosimendan. Compared with control patients, levosimendan-treated patients had lower postoperative troponin I concentrations (P0.05) and a higher cardiac index (P0.05). Conclusion. Patients receiving a short infusion of levosimendan before CABG showed evidence of less myocardial damage, suggestive of a preconditioning effect. Larger outcome studies are thus indicated to confirm benefit.