الفهرس 
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Abstract
This randomized study was performed at cardiothoracic surgery department of Menoufia University hospital and Nasser Institute hospital from the period between January 2017 and July 2019.
Ninety patients presented with coronary insufficiency were subjected to CABG surgery.
Pre-operative echocardiography revealed poor left ventricular ejection fraction less than 35%.
The patients were subdivided into three groups 30 in group (A) wouldn’t be submitted to prophylactic levosimendan nor IABP and 30 in group (B) submitted to intra-aortic balloon pump and 30 in group (B) submitted to prophylactic infusion of levosimendan with the induction of anesthesia.
To evaluate and compare the effect of levosimendan and IABP in patients with poor left ventricular function undergoing coronary artery bypass graft surgery: all patients were evaluated thoroughly preoperative , intra-operative and postoperative , especially the duration of mechanical ventilation , use of inotropes, hospital stay and mortality.
Results:
The results of our research suggest that prophylactic preoperative supports with IABP or levosimendan improve the results, and decrease the morbidity and amount of inotropic supports in patients with poor left ventricular ejection fraction.
Prophylactic preoperative levosimendan infusion had significant decrease in ICU stay and ICU complications associated with IABP as bleeding and other vascular complications. But it significant decrease blood pressure in the early postoperative period.
Conclusion & Recommendations
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CONCLUSION & RECOMMENDATIONS
Conclusion:
We can conclude that patients with an ejection fraction of less than 35 % are at high risk of developing postoperative low cardiac output syndrome (LCOS) following cardiac surgery.
Prophylactic preoperative supports with IABP or levosimendan improve the results, and decrease the morbidity and amount of inotropic supports in patients with poor left ventricular ejection fraction..
Prophylactic preoperative levosimendan infusion had significant decrease in ICU stay and ICU complications associated with IABP as bleeding and other vascular complications. But it significant decrease blood pressure in the early postoperative period.
Recommendations:
Starting preoperative levosimendan infusion after induction of anesthesia can be used as alternative to IABP in patients with poor left ventricular function maintaining stable hemodynamic during and after operations under CPB and had less ICU stay.
Study the long term outcome of preoperative prophylactic supports in patients with poor left ventricular function with bigger sample size.