الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The risk profile of patients undergoing CABG has increased significantly. Patients with a severely depressed left ventricular ejection fraction (LVEF<35%) are particularly at increased risk of developing postoperative complications such as low cardiac output syndrome (LCOS), which in turn is associated with higher mortality.
Patients with poor left ventricular function undergoing cardiac surgery frequently require inotropic drug support immediately after cardiopulmonary bypass (CPB).
Preexisting impaired ventricular function is further compromised by variable degrees of myocardial stunning and/or myocardial injury resulting from ischemia during aortic cross clamping.
Levosimendan, a calcium-sensitizing inotrope and an ATP-sensitive potassium channel (KATP) opener, a pharmacological strategy to decrease mortality in cardiac surgery. The intraoperative use of levosimendan together with good cardiac preservation during cross clamp with custodiole are mainly rescue strategy for those patients and who might be with difficult weaning from cardiopulmonary bypass (CPB) or in cases of LCOS.
Levosimendan seems to be an effective drug in decreasing VIS score and thus limiting postoperative complications and mortality with cost benefits in developing countries.