Elderly patients with heart failure undergoing urgent major surgery suffer substantial cardiac morbidity and mortality. Levosimendan, a novel calcium sensitizer, enhances myocardial contractility while simultaneously having vasodilatory and cardioprotective properties. This could be advantageous in perioperative management of heart failure patients.

Ten consecutive patients with symptomatic heart failure and left ventricular ejection fraction <35% undergoing urgent hip fracture repair were studied. Levosimendan was administered with an infusion rate of 0.1 μg kg−1 min−1 in a total dose of 12.5 mg starting a minimum of 2 h prior to surgery. Haemodynamic parameters were obtained at baseline and at 4, 8, 12, 16, 20, 24, 28, 36 and 48 h after start of levosimendan. B-type natriuretic peptide was measured on admission and after 48 h.

Patients were 86 ± 7 yr (mean ± SD) of age. Levosimendan significantly increased cardiac index from 2.4 ± 0.3 L min−1 m−2 at baseline to 3.2 ± 0.6 L min−1 m−2 after 24 h by increases in stroke volume index (baseline 27 ± 5 mL m−2, after 24 h 37 ± 10 mL m−2, P < 0.05). Systemic vascular resistance index significantly decreased from 2718 ± 841 to 1964 ± 385 dyn s cm−5 m−2 within 24 h. Haemodynamic changes exerted by levosimendan persisted up to 48 h. B-type natriuretic peptide plasma concentrations decreased from 1143 ± 792 to 935 ± 724 ng L−1 after 48 h (P = 0.006).

In patients with heart failure, preoperative start of levosimendan infusion improves intraoperative and postoperative haemodynamics. These findings suggest that levosimendan is a useful drug for preoperative optimization of cardiac function in high-risk patients undergoing major surgery.