Preoperative optimization with levosimendan in heart failure patient undergoing thoracic surgery

• The use of levosimendan for perioperative optimization of patients undergoing cardiac surgery has been reported in several studies, however it has not been thouroughly evaluated in cardiac failure patients undergoing non cardiac surgery.
• Preoperative levosimendan administration is safe and effective in cardiac failure patient undergoing thoracic surgery.
• Prophylactic preoperative levosimendan treatment in heart failure patients merits further study.

IntroductionWe present the case of a patient with dilatative cardiomyopathy waiting for heart transplantation with pleural effusion to be subjected to pleural biopsy, treated with preoperative infusion of levosimendan to improve heart performances.Presentation of caseA 56-year-old man (BMI 22,49) with dilatative cardiomyopathy (EF 18%) presented right pleural effusion. The levosimendan treatment protocol consisted of 24 h continuous infusion (0,1 ug/kg/min), without bolus. The patient was under continuous hemodynamic monitoring prior, during and after levosimendan administration. The surgery for pleural biopsy was performed with uniportal Video Assisted Thoracoscopic approach (VATS).DiscussionA significant increase of Cardiac Index (CI) and Stroke Volume Index (SVI) were observed at 4 h after infusion initiation and was sustained during the next 24 h after the end of infusion. Levosimendan administration was safe.ConclusionIn this case the prophylactic preoperative levosimendan administration is safe and effective in cardiac failure patient undergoing thoracic surgery, but prophylactic preoperative levosimendan treatment in these patients merits further study.