Reducing Mortality in Cardiac Surgery With Levosimendan: A Meta-analysis of Randomized Controlled Trials

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 24; no. 1; pp. 51 - 57
• Main Authors: Landoni, Giovanni, MD, Mizzi, Anna, MD, Biondi-Zoccai, Giuseppe, MD, Bruno, Giovanna, MD, Bignami, Elena, MD, Corno, Laura, MD, Zambon, Massimo, MD, Gerli, Chiara, MD, Zangrillo, Alberto, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2010
• Subjects: Anesthesia & Perioperative Care; cardiac anesthesia; cardiac biomarker; cardiac surgery; Cardiopulmonary Bypass - methods; Cardiopulmonary Bypass - mortality; Cardiotonic Agents - therapeutic use; Coronary Artery Bypass, Off-Pump - methods; Coronary Artery Bypass, Off-Pump - mortality; Critical Care; Heart Diseases - mortality; Heart Diseases - surgery; Humans; Hydrazones - therapeutic use; inotropic drug; levosimendan; meta-analysis; mortality; Postoperative Complications - mortality; Pyridazines - therapeutic use; Randomized Controlled Trials as Topic; Treatment Outcome; troponin; troponin; cardiac biomarker; levosimendan; cardiac anesthesia; meta-analysis; mortality; cardiac surgery; inotropic drug
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2009.05.031

Objectives The authors performed a meta-analysis to evaluate whether levosimendan is associated with improved survival in patients undergoing cardiac surgery. Design A meta-analysis. Setting Hospitals. Participants A total of 440 patients from 10 randomized controlled studies were included in the analysis. Interventions None. Measurments and Main Results Four investigators independently searched BioMedCentral and PubMed. Inclusion criteria were random allocation to treatment, comparison of levosimendan versus control, and cardiac surgery patients. Exclusion criteria were duplicate publications, nonhuman experimental studies, and no mortality data. The primary endpoint was postoperative mortality. Levosimendan was associated with a significant reduction in postoperative mortality (11/235 [4.7%] in the levosimendan group v 26/205 [12.7%] in the control arm, odds ratio = 0.35 [0.18-0.71], p for effect = 0.003, p for heterogeneity = 0.22, I2 = 27.4% with 440 patients included), cardiac troponin release, and atrial fibrillation. No difference was found in terms of myocardial infarction, acute renal failure, time on mechanical ventilation, intensive care unit, and hospital stay. Conclusions Levosimendan has cardioprotective effects that could result in a reduced postoperative mortality. A large randomized controlled study is warranted in this setting.