Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Critical Care Medicine

Background: Coronary artery bypass graft (CABG) surgery is the standard of care for the management of patients with three-vessel and left main coronary artery disease (CAD) with viable myocardium. Positive inotropic agents are the treatment of choice in patients with LV dysfunction post CABG. Levosimendan is an inotropic drug that has three major mechanisms of action: positive inotropy, vasodilation, and cardiac cytoprotection. Levosimendan is a calcium sensitizer, it improves myocardial contractility by sensitising troponin C to calcium without increasing myocardial oxygen consumption and without impairing relaxation and diastolic function. aim: The aim of this study was to determine the effect of levosimendan compared to the conventional inotropic agents on the outcomes of patients with LV dysfunction undergoing CABG. methods: It is prospective cohort study that patients were divided into 2 groups of 50 patients each. Group A received intravenous levosimendan (at a dose of 0.2og per kilogram of body weight per minute for 1 hour, followed by a dose of 0.1og per kilogram per minute for 23 hours), with the infusion started at the induction of anesthesia while Group B which included patients who received conventional drugs. Clinical examination, Hemodynamic data and Laboratory investigations pre-operative and post-operative were collected. results: Our study showed that Levosimendan had significantly improved postoperative outcomes. There was statistically significant difference between studied groups in terms of postoperative LVEF (p =0.075). Also, there was statistically significant difference between studied groups in terms of postoperative heart rate (p =0.001). Moreover,There was statistically significant difference between studied groups in terms of mortality (p =0.004)

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