Preoperative Levosimendan in Patients With Severe Left Ventricular Dysfunction Undergoing Isolated Coronary Artery Bypass Grafting: A Meta-Analysis of Randomized Controlled Trials.

Abstract

OBJECTIVE:

To verify the impact of preoperative levosimendan on patients with severe left ventricular dysfunction (ejection fraction <35%) undergoing isolated coronary artery bypass grafting.

DESIGN:

A meta-analysis.

SETTING:

Hospitals.

PARTICIPANTS:

The authors included 1,225 patients from 6 randomized controlled trials.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The authors performed a meta-analysis of trials that compared preoperative levosimendan with placebo or no therapy, reporting efficacy and safety endpoints. Statistical analyses used mean differences and risk ratios (RR), with a random effects model. Six studies were included, comprising 1,225 patients, of whom 615 (50.2%) received preoperative levosimendan, and 610 (49.8%) received placebo/no therapy. Preoperative levosimendan showed a lower risk of all-cause mortality (RR 0.31; 95% CI 0.16-0.60; p < 0.01; I2 = 0%), postoperative acute kidney injury (RR 0.44; 95% CI 0.25-0.77; p < 0.01; I2 = 0%), low-cardiac-output syndrome (RR 0.45; 95% CI 0.30-0.66; p < 0.001; I2 = 0%), and postoperative atrial fibrillation (RR 0.49; 95% CI 0.25-0.98; p = 0.04; I2 = 85%) compared to control. Moreover, levosimendan significantly reduced the need for postoperative inotropes and increased the cardiac index at 24 hours postoperatively. There were no differences between groups for perioperative myocardial infarction, hypotension, or any adverse events.

CONCLUSION:

Preoperative levosimendan in patients with severe left ventricular dysfunction undergoing isolated coronary artery bypass grafting was associated with reduced all-cause mortality, low-cardiac-output syndrome, acute kidney injury, postoperative atrial fibrillation, and the need for circulatory support without compromising safety.

• Authors: Rafael Ayala, Douglas Mesadri Gewehr, Amanda Godoi, Camilo Velasquez, Miguel Fernandez, Pedro E P Carvalho, Nora Goebel
• Journal: Journal of cardiothoracic and vascular anesthesia (J Cardiothorac Vasc Anesth) Vol. 38 Issue 3 Pg. 649-659 (Mar 2024) ISSN: 1532-8422 [Electronic] United States
• PMID: 38228424 (Publication Type: Meta-Analysis, Journal Article)
• Copyright: Copyright © 2023 Elsevier Inc. All rights reserved.

Chemical References

• Cardiotonic Agents
• Simendan

Topics

• Humans
• Acute Kidney Injury (etiology)
• Atrial Fibrillation (etiology)
• Cardiac Output, Low (drug therapy, etiology)
• Cardiotonic Agents (therapeutic use)
• Coronary Artery Bypass (adverse effects)
• Postoperative Complications (epidemiology, prevention & control, drug therapy)
• Randomized Controlled Trials as Topic
• Simendan (therapeutic use)
• Ventricular Dysfunction, Left