Article description

Summary:

• This meta-analysis aimed to evaluate the effects of levosimendan on patients with severe left ventricular dysfunction (ejection fraction (EF) <35%) undergoing isolated coronary artery bypass grafting (CABG);
• Meta-analysis of randomized controlled trials (RCT);
• The study included 6 randomized controlled trials with a study population sample size of 1,225 patients, of whom 615 (50.2%) received preoperative levosimendan, and 610 (49.8%) received placebo/no therapy.
• Primary outcomes showed significantly lower all-cause mortality in the preoperative levosimendan group ( (RR 0.31; 95% CI 0.16-0.60; p < 0.01; I2 = 0%; n = 5 studies; moderate certainty of evidence(CE)), acute kidney injury or need for dialysis (RR 0.44; 95% CI 0.25-0.77; p < 0.01; I2 = 0%; n = 4 studies; moderate CE), low-cardiac-output syndrome (RR 0.45; 95% CI 0.30-0.66; p < 0.001; I2 = 0%; n = 4 studies; moderate CE), and postoperative AF and/or flutter (RR 0.49; 95% CI 0.25-0.98; p = 0.04; I2 = 85%; n = 6 studies) compared to control.
• Secondary outcomes showed a significantly reduced need for postoperative inotropic agents (RR 0.38; 95% CI 0.15-0.95; p = 0.04; I2 = 91%; n = 4 studies) and a higher cardiac index at 24 hours postoperatively (MD 0.53 L/ min/m2; 95% CI 0.09-0.97 L/min/m2; p = 0.02; I2 = 98%; n = 3 studies) in the preoperative levosimendan group compared to control.
• No differences between groups in perioperative myocardial infarction, hypotension, or any adverse events were detected;

Conclusions:

• Preoperative levosimendan in patients with severe left ventricular dysfunction undergoing isolated CABG 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.

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