UTJECAJ VREMENA PRIMJENE LEVOSIMENDANA NA ISHOD KIRURŠKOG LIJEČENJA KORONARNE BOLESTI U KBC-u SPLIT OD 2009. DO 2014. GODINE

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Objectives and background: Recently, levosimendan, a member of a new class of agents, calcium sensitizer, has emerged as a new inotropic agent, which increases myocardial contractility without increasing intracellular calcium levels. Its common use in cardiac surgery impacted the aim of this research. Establishing the existence of differences in the outcome of surgical treatment coronary artery disease among groups of patients that differ in time of levosimendan application. Patients and Methods: From August 2009 until December 2014 case records of 69 surgically treated coronary patients under levosimendan treatment were retrospectively reviewed. Patients were classified in groups, considering the time of administration of levosimendan. Group 1 consisted of patients in whom levosimendan was used as the first perfusor. Group 2 consisted of patients in whom levosimendan was used as a second or each subsequent perfusor. The group 3 consists of patients in whom levosimendan is administered postoperatively, in combined infusion. Each patient was analyzed for following parameters: EuroSCORE II, the time of levosimendan administration, number of days spent in cardiac ICU, gender, type of surgery. Results: The minimum number of days spent in the cardiac ICU was registered in the group of patients in which levosimendan is applied as the first perfusor. Median of days in cardiac ICU for this group was 4.55. Significantly highest number of days spent in cardiac ICU was recorded in the group where levosimendan is administered postoperatively (P = 0.001). The median value for this group was 14.93 days stay in cardiac ICU. The subgroup of the group 1 consists of 6 patients in which levosimendan is used as the first and only perfusor. The mean stay in cardiac ICU for this group was 3.55 days, and the mortality was 0% .Although not statistically significant, the lowest mortality was observed in the group where levosimendan is used as first perfusor (12.12%), the Compared with other groups (16.67%). There is no statistically significant difference between groups in gender, type of operation, or the median values of a EuroSCORE. Conclusions: Early use of levosimendan in surgical patients with an isolated diagnosis of coronary artery disease reduces the length of stay in cardiac ICU in relation to the late application. Although not statistically significant, early application of levosimendan reduces mortality.

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