Levosimendan, a new therapeutic approach to prevent delayed cerebral vasospasm after subarachnoid hemorrhage?
OBJECTIVES Hypothermic circulatory arrest (HCA) provides an optimal operating field in aortic arch surgery, but it is associated with neurological complications. Levosimendan is an inotropic agent with clinical indications for open-heart surgery. Through peripheral vasodilatation, cardiac contractility enhancement and anti-inflammatory function it has a potential to improve cerebral protection after HCA. DESIGN Eighteen piglets were randomly assigned to a levosimendan group (n = 9) and a placebo group (n = 9) and underwent a 60-minute period of hypothermic circulatory arrest at 18°C. A levosimendan or placebo infusion (0.2 μg/kg/min) was commenced at the onset of anesthesia and continued for 24 hours. Animals were followed for one week and their neurological recovery was assessed daily. Finally the animals were electively sacrificed and their brain was harvested for histopathological examination. RESULTS Levosimendan decreased intracranial pressure during the experiment. There were no differences between the groups in terms of hemodynamic or metabolic data, brain metabolism, neurological recovery or histopathology of the cerebral tissue. In the levosimendan group, cardiac enzymes were slightly more elevated. CONCLUSIONS Levosimendan decreased intracranial pressure during the experiment, but in terms of cerebral metabolism, neurological recovery and histopathology of the brain tissue levosimendan did not improve brain protection in this experimental setting.