PREOPERATIVE VARIATIONS ASSESSMENT IN PATIENTS WITH LOW EJECTION FRACTION
Keywords:
coronary bypass grafting surgery, levosimendan, low ejection fraction, multifocal atherosclerosisAbstract
Purpose: preoperative assessment optimization for coronary artery bypass grafting surgery in patients with multifocal atherosclerosis with an initially low left ventricle ejection fraction. Materials and methods: double blind randomized study of 91 males (59.6± ±14.6) years of age with multifocal atherosclerosis suffering from coronary artery diseases with an initially low left ventricle ejection fraction (< 42%). Intraaortic counterpulsation (n=28), dobutamine (n=19), levosimendan (n=33) the control group with placebo (n=11) in a background therapy were used in the preoperative assessment for an elective coronary artery bypass grafting surgery. The assessment efficiency was compared by the central and intracardiac hemodynamics parameters, the hydrodynamics status on the basis of the transpulmonary thermodilution and ultrasonic echocardiography with pulsed wave Doppler data and by the obtained clinical results. Results. The benefits of the levosimendan administration were verified by the extravascular lung water indicators, the diastolic myocardial function improvement, reduced manifestations frequency of postoperative multiple organ dysfunction, reduced admission time in the ICU for survived patients, a relative decline in the mortality rate. Conclusions. The results obtained suggest that the levosimendan administration for the preoperative assessment in patients with multifocal atherosclerosis and relative contraindications for the IABP placement, helps to improve the central hemodynamics parameters, reduce the severe diastolic dysfunction, without changes in the hydrodynamics, reduce the organ dysfunction frequency, to reduce the ICU time admission.
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