Perioperative Use of Levosimendan: Best Practice in Operative Settings

LEVOSIMENDAN HAS BEEN USED in clinical practice since 2000, especially in the care of heart-failure patients. It probably is the most studied inotropic agent ever, with 83 randomized controlled trials published about adult critically ill patients1 (PubMed search updated January 6, 2012). The molecular mechanisms of levosimendan action recently have been described in detail elsewhere2 and are based on, but not limited to, the Ca2-sensitizing effect in the cardiac myofilaments. Pleiotropic effects include activation of adenosine triphosphate– sensitive sarcolemmal K channels of smooth muscle cells (linked to vasodilation) and activation of adenosine triphosphate– sensitive K channels in cardiovascular mitochondria (involved in a cardioprotective effect). The active long-lived metabolite OR-1896, also an inodilator,3,4 allows the cardiovascular effects of levosimendan to persist up to 7 to 9 days after the discontinuation of a 24-hour infusion of the drug.