Levosimendan in Patients with Left Ventricular Dysfunction Undergoing Cardiac Surgery: An Update Meta-Analysis and Trial Sequential Analysis

• Published in: BioMed research international Vol. 2018; no. 2018; pp. 1 - 10
• Main Authors: Cheng, Bihuan, Gong, Yuqiang, He, Xiaojie, Wang, Benji
• Format: Journal Article
• Language: English
• Published: Cairo, Egypt Hindawi Publishing Corporation 01.01.2018; Hindawi; John Wiley & Sons, Inc; Hindawi Limited
• Subjects: Analysis; Atrial fibrillation; Capillary pressure; Cardiac output; Cardiac Output, Low - drug therapy; Cardiac Output, Low - surgery; Cardiac patients; Cardiac Surgical Procedures - methods; Cardiotonic Agents - therapeutic use; Care and treatment; Clinical trials; Coronary vessels; Drug dosages; Fibrillation; Health aspects; Heart diseases; Heart surgery; Humans; Hydrazones - therapeutic use; Medical research; Meta-analysis; Mortality; Patients; Postoperative Complications - prevention & control; Pyridazines - therapeutic use; Randomization; Randomized Controlled Trials as Topic; Reliability analysis; Renal Replacement Therapy; Review; Sequential analysis; Studies; Surgery; Systematic review; Therapy; Thoracic surgery; Ventricle; Ventricular Dysfunction, Left - drug therapy; Ventricular Dysfunction, Left - surgery
• ISSN: 2314-6133; 2314-6141
• DOI: 10.1155/2018/7563083

Background. Recent studies suggest that levosimendan does not provide mortality benefit in patients with low cardiac output syndrome undergoing cardiac surgery. These results conflict with previous findings. The aim of the current study is to assess whether levosimendan reduces postoperative mortality in patients with impaired left ventricular function (mean EF ≤ 40%) undergoing cardiac surgery. Methods. We conducted a comprehensive search of PubMed, EMBASE, and Cochrane Library Database through November 20, 2017. Inclusion criteria were random allocation to treatment with at least one group receiving levosimendan and another group receiving placebo or other treatments and cardiac surgery patients with a left ventricular ejection fraction of 40% or less. The primary endpoint was postoperative mortality. Secondary outcomes were cardiac index, pulmonary capillary wedge pressure (PCWP), length of intensive care unit (ICU) stay, postoperative atrial fibrillation, and postoperative renal replacement therapy. We performed trial sequential analysis (TSA) to evaluate the reliability of the primary endpoint. Results. Data from 2,152 patients in 15 randomized clinical trials were analyzed. Pooled results demonstrated a reduction in postoperative mortality in the levosimendan group [RR = 0.53, 95% CI (0.38–0.73), I2=0]. However, the result of TSA showed that the conclusion may be a false positive. Secondary outcomes demonstrated that PCWP, postoperative renal replacement therapy, and length of ICU stay were significantly reduced. Cardiac index was greater in the levosimendan group. No difference was found in the rate of postoperative atrial fibrillation. Conclusions. Levosimendan reduces the rate of death and other adverse outcomes in patients with low ejection fraction who were undergoing cardiac surgery, but results remain inconclusive. More large-volume randomized clinical trials (RCTs) are warranted.