Effects Of Levosimendan In Patients With Low Ejection Fraction Undergoing Cardiac Surgery:a Meta-Analysis Of Randomized Controlled Trials

Purpose:Levosimendan, a new inotropic drug for the treatment of decompensated heart failure, has also shown promise in elective therapy of cardiac surgical patients. However, the efficacy and safety of levosimendan in high-risk patients with impaired cardiac function has not been well established. This study reviews the perioperative intravenous usage of levosimendan in patients with low ejection fraction undergoing cardiac surgery.Methods:PubMed, EMBASE and BioMedCentral were used for a literature search relating to the effects of levosimendan in adult patients with preoperative left ventricular dysfunction with at least one outcome of interest. Relevant outcomes included mortality, postoperative complications, need for additional inotropic or mechanical therapy and length of stay in intensive care unit. The analysis was performed with Revman5.2.Heterogeneity was measured using the Cochrane Q test and quantified with the12statistic. Binary outcomes from individual studies were analyzed by means of the M-H fixed-effect method in case of low or moderate statistical inconsistency (I2<50%) and with the random-effect model in case of high statistical inconsistency (I2>50%). Standardized mean difference (SMD) and95%confidence interval (CI) were calculated for continuous variables. The risk for small study bias was assessed by visual inspection of funnel plots. Statistical significance was set at the2-tailed0.05level for hypothesis testing.Results:Nine studies with a total of650patients with systolic left ventricular dysfunction were analyzed. Compared with a control intervention, levosimendan was associated with a significant reduction in mortality (odds ratios=0.27,95%CI0.15to0.51, p<0.0001). Similar differences were also observed in the rate of atrial fibrillation, myocardial injury and renal dysfunction. Although patients received levosimendan tended to have a shorter length of stay in ICU, There was no statistical difference in this meta-analysis.(SMD=-0.74days,[-1.56to0.08], p=0.08).Conclusions:Perioperative use of levosimendan for high-risk patients undergoing cardiac surgery resulted in a reduced postoperative mortality and complications. Larger randomized controlled clinical trials are warranted to confirm these findings.