Low cardiac output syndrome (LCOS) following cardiac surgery is characterized by myocardial
dysfunction requiring inotropic and mechanical circulatory support and is associated
with high morbidity and mortality. Levosimendan, an inodilator that facilitates calcium
sensitization of troponin C, has been identified as potential prophylactic cardioprotective
treatment for LCOS in patients undergoing cardiac surgery.1 Recent randomized control trials, LEVO-CTS, LICORN and CHEETAH, have not demonstrated
prophylactic levosimendan mortality benefit however there may be decreased incidence
of LCOS with its use.2-4 It's also possible there remains a therapeutic window of levosimendan in mitigating
LCOS that should be investigated. These trials suggest that LCOS mortality may be
driven by prolonged cardiopulmonary bypass (CPB) and aortic cross clamp time as well
as coronary artery bypass graft surgery with the addition of valvular intervention.
Minimizing surgical risk as well as identifying risk factors for LCOS are imperative
for mortality reduction in cardiac surgery.
Keywords
Abbreviations:
CPB (cardiopulmonary bypass), EF (ejection fraction), LCOS (low cardiac output syndrome)To read this article in full you will need to make a payment
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