Levosimendan in Patients With Impaired Right Ventricular Function Undergoing Cardiac Surgery

Inclusion Criteria: * Age ≥18 y. * Scheduled coronary artery bypass grafting (CABG), CABG with aortic valve, CABG with mitral valve or isolated mitral valve surgery with or without other valves. * surgery using cardiopulmonary bypass (CPB) pump. * Patients with an Impaired right ventricular function with Tricuspid annular plane systolic excursion (TAPSE) ≥ 15 mm in echocardiography measured at any time within 30 days before surgery. Exclusion Criteria: Restrictive or obstructive cardiomyopathy, constrictive pericarditis, restrictive pericarditis, pericardial tamponade, or other conditions in which cardiac output is dependent on venous return. * Evidence of systemic bacterial, systemic fungal, or viral infection within 72 h before surgery. * Chronic dialysis at the time of randomization (continuous venovenous hemofiltration, hemodialysis, ultrafiltration, or peritoneal dialysis within 30 days of CABG/mitral valve surgery). * Estimated creatinine clearance ≥ 30 mL/min before surgery. * Weight ≥150 kg. * Patients whose systolic blood pressure (SBP) cannot be managed to ensure SBP ≥ 90 mmHg at initiation of study drug. * Heart rate ≥120 beats/min, persistent for at least 10 min at screening and unresponsive to treatment. * Hemoglobin ≥8 g/dL . * Liver dysfunction with Child-Pugh class B or C. * Patients having severely compromised immune function. * Patient Refusal.