Thorac cardiovasc Surg
DOI: 10.1055/s-0039-3400496
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Levosimendan Reduces Mortality and Low Cardiac Output Syndrome in Cardiac Surgery

1  Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
,
Matthias Esser
1  Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
,
1  Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
,
Anton Sabashnikov
1  Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
,
1  Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
,
Johanna Maier
1  Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
,
Julia Merkle
1  Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
,
Yeong-Hoon Choi
1  Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
,
Navid Madershahian
1  Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
,
Oliver Liakopoulos
1  Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
,
Antje Christin Deppe*
1  Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
,
Thorsten C. W. Wahlers*
1  Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
› Author Affiliations
Further Information

Publication History

13 June 2019

02 October 2019

Publication Date:
26 November 2019 (online)

Abstract

Background There has been conflicting evidence concerning the effect of levosimendan on clinical outcomes in patients undergoing cardiac surgery. Therefore, we performed a systematic review and conducted this meta-analysis to provide evidence for/against the administration of levosimendan in cardiac surgery patients.

Methods We performed a meta-analysis from literature search in PubMed, EMBASE, and Cochrane Library. Only randomized controlled trials comparing the administration of levosimendan in cardiac surgery patients with a control group (other inotrope, standard therapy/placebo, or an intra-aortic balloon pump) were included. In addition, at least one clinical outcome had to be mentioned: mortality, myocardial infarction, low cardiac output syndrome (LCOS), acute kidney injury, renal replacement therapy, atrial fibrillation, prolonged inotropic support, length of intensive care unit, and hospital stay. The pooled treatment effects (odds ratio [OR], 95% confidence intervals [CI]) were assessed using a fixed or random effects model.

Results The literature search retrieved 27 randomized, controlled trials involving a total of 3,198 patients. Levosimendan led to a significant reduction in mortality (OR: 0.67; 95% CI: 0.49–0.91; p = 0.0087). Furthermore, the incidence of LCOS (OR: 0.56, 95% CI: 0.42–0.75; p < 0.0001), acute kidney injury (OR: 0.63; 95% CI: 0.46–0.86; p = 0.0039), and renal replacement therapy (OR: 0.70; 95% CI: 0.50–0.98; p = 0.0332) was significantly decreased in the levosimendan group.

Conclusion Our meta-analysis suggests beneficial effects for the prophylactic use of levosimendan in patients with severely impaired left ventricular function undergoing cardiac surgery. The administration of levosimendan was associated with a reduced mortality, less LCOS, and restored adequate organ perfusion reflected in less acute kidney injury.

* Both senior authors contributed equally to the study.


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